{ "hospital_name": "Lincoln Health", "last_updated_on": "2026-03-19", "version": "3.0.0", "location_name": [ "Lincoln Health" ], "hospital_address": [ "111 6th St, , Hugo, CO 80821" ], "license_information": { "state": "CO", "license_number": "NA" }, "type_2_npi": [ "281720107519" ], "attestation": { "attestation": "To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.", "confirm_attestation": true, "attester_name": "Christine Barrington, CFO" }, "standard_charge_information": [ { "description": "Gastrointestinal hemorrhage with cc", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 9039.04, "discounted_cash": 9039.04, "minimum": 12177.00, "maximum": 12177.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE", "standard_charge_dollar": 12177.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Other kidney and urinary tract diagnoses with cc", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 35214.57, "discounted_cash": 35214.57, "minimum": 12177.00, "maximum": 12177.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE", "standard_charge_dollar": 12177.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Red blood cell disorders without mcc", "code_information": [ { "code": "812", "type": "MS-DRG" } ], "standard_charges": [ { "gross_charge": 18480.51, "discounted_cash": 18480.51, "minimum": 12177.00, "maximum": 12177.00, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE", "standard_charge_dollar": 12177.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "DRG Fee Schedule" } ] } ] }, { "description": "Olanzapine 10 mg im inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00002EA7597EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 117.12, "discounted_cash": 117.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apixaban 2.5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00003EA0893EA21", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 31.74, "discounted_cash": 31.74, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apixaban 2.5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00003EA0893EA31", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 31.74, "discounted_cash": 31.74, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sitagliptin 50 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00006EA0112EA31", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 62.57, "discounted_cash": 62.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sitagliptin 50 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00006EA0112EA54", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 62.57, "discounted_cash": 62.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oseltamivir 75 mg cap", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00004EA0800EA85", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 54.68, "discounted_cash": 54.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rotavirus vaccine pentavalent oral susp [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "00006EA4047EA41", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 223.35, "discounted_cash": 223.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis a adult vaccine 50 units/ml im susp syringe [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "00006EA4096EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 275.64, "discounted_cash": 275.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Measles/mumps/rubella/varicella virus vaccine ea", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "00006EA4171EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 533.55, "discounted_cash": 533.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sugammadex 100 mg/ml 2 ml [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "00006EA5423EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 249.31, "discounted_cash": 249.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Varicella virus vaccine ea", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00006EA4827EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 324.49, "discounted_cash": 324.49, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Linezolid 600 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00009EA5135EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 374.46, "discounted_cash": 374.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ocular lubricant gel 15 ml [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "00023EA9205EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.94, "discounted_cash": 18.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium polystyrene sulfonate pwdr [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00024EA1075EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.66, "discounted_cash": 4.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Quetiapine 50 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00054EA0229EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluticasoneeasalmeterol 100 mcgea50 mcg ea pwdr [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00054EA0326EA56", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.05, "discounted_cash": 12.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Morphine 20 mg/ml oral conc [lchn]", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "00054EA0404EA44", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.40, "discounted_cash": 50.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Morphine 20 mg/ml oral conc [lchn]", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "00054EA0517EA44", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.40, "discounted_cash": 50.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 30 mg/30 ml oral conc [lchn]", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "00054EA3176EA44", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 96.51, "discounted_cash": 96.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Warfarin 4 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00056EA0168EA75", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.72, "discounted_cash": 10.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Warfarin 1 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00056EA0169EA75", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.90, "discounted_cash": 9.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Collagenase 250 units/g top oint 30 gm [lchn]", "drug_information": { "unit": 30.00, "type": "EA" }, "code_information": [ { "code": "00064EA5010EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 491.52, "discounted_cash": 491.52, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tobramycin 0.3% ophth oint 3.5 g [lchn]", "drug_information": { 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calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasoneeatobramycin 0.1%ea0.3% ophth susp 2.5 ml [lchn]", "drug_information": { "unit": 2.50, "type": "EA" }, "code_information": [ { "code": "00065EA0647EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 190.04, "discounted_cash": 190.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tetracaine 0.5% ophth sol [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "00065EA0741EA14", "type": "NDC" } ], "standard_charges": [ { 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diclofenac 1% top gel [lchn]", "drug_information": { "unit": 100.00, "type": "EA" }, "code_information": [ { "code": "00067EA8152EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.27, "discounted_cash": 40.27, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine 4% top sol 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "EA" }, "code_information": [ { "code": "00054EA3505EA47", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 96.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nitroglycerin 0.4 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00071EA0418EA24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gabapentin 100 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00071EA0803EA24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.37, "discounted_cash": 12.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pregabalin 75 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00071EA1014EA41", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.67, "discounted_cash": 35.67, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenytoin 25 mg/ml", "drug_information": { "unit": 237.00, "type": "ML" }, "code_information": [ { "code": "00071EA2214EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 407.06, "discounted_cash": 407.06, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Beractant 100 mg/4 ml intratracheal susp [lchn]", "drug_information": { "unit": 4.00, "type": "ML" }, "code_information": [ { "code": "00074EA1040EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 766.00, "discounted_cash": 766.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Valsartan 80 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00078EA0358EA34", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.27, "discounted_cash": 28.27, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxcarbazepine 600 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00078EA0457EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 57.74, "discounted_cash": 57.74, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carbamazepine 100 mg/5 ml oral susp 450 ml [lchn]", "drug_information": { "unit": 450.00, "type": "ML" }, "code_information": [ { "code": "00078EA0508EA83", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 391.68, "discounted_cash": 391.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sacubitrileavalsartan 24 mgea26 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00078EA0659EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 38.17, "discounted_cash": 38.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac 10 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00093EA0314EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.63, "discounted_cash": 8.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diltiazem 30 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00093EA0318EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albuterol 2 mg/5 ml", "drug_information": { "unit": 473.00, "type": "ML" }, "code_information": [ { "code": "00093EA0661EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 175.50, "discounted_cash": 175.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Warfarin 1 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00093EA1712EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoclopramide 10 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00093EA2203EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amoxicillineaclavulanate 500 mgea125 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00093EA2274EA34", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.14, "discounted_cash": 15.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cephalexin 250 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00093EA3145EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mexiletine 200 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00093EA8740EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.11, "discounted_cash": 12.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaineeaprilocaine 2.5%ea2.5% top crm 30 g [lchn]", "drug_information": { "unit": 30.00, "type": "EA" }, "code_information": [ { "code": "00115EA1468EA45", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 92.14, "discounted_cash": 92.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrocortisone 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00115EA1697EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chlorhexidine topical 0.12%", "drug_information": { "unit": 473.00, "type": "ML" }, "code_information": [ { "code": "00116EA2001EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nystatin 500000 units/5 ml oral susp [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "00121EA0868EA50", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.72, "discounted_cash": 6.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Al hydroxide/mg hydroxide/simethicone 200 mgea200 mgea20 mg/5 ml", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "00121EA1761EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.17, "discounted_cash": 15.17, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Codeineeaguaifenesin 10 mgea100 mg/5 ml", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "00121EA1775EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glycerin adult supp [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00132EA0079EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcium carbonate 750 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00135EA0074EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcium carbonate 750 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00135EA0178EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 4 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00054EA4184EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.76, "discounted_cash": 4.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 4 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00054EA8175EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.82, "discounted_cash": 4.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketamine 500 mg/10 ml inj sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "00143EA9508EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enalapril 1.25 mg/ml sol", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "00143EA9786EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of 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"payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Doxycycline hyclate 100 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00143EA9803EA50", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.60, "discounted_cash": 16.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluticasoneeasalmeterol 100 mcgea50 mcg ea pwdr [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00173EA0695EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.01, "discounted_cash": 26.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluticasoneeasalmeterol 250 mcgea50 mcg ea pwdr [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00173EA0696EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.01, "discounted_cash": 26.01, 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] }, { "description": "Fluticasoneeasalmeterol 500 mcgea50 mcg ea pwdr [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00173EA0697EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 20.72, "discounted_cash": 20.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": 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"plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluticasoneeasalmeterol 500 mcgea50 mcg ea pwdr [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00173EA0697EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 42.39, "discounted_cash": 42.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluticasone cfc free 110 mcg/ea ea aer w/adapter 12 g [lchn]", "drug_information": { "unit": 12.00, "type": "EA" }, "code_information": [ { "code": "00173EA0719EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 657.20, "discounted_cash": 657.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": 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{ "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Umeclidinium 62.5 mcg (0.0625 mg)/ea pow [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00173EA0873EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.98, "discounted_cash": 24.98, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bisoprolol 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00185EA0771EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.88, "discounted_cash": 4.88, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metolazone 2.5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00185EA5050EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.29, "discounted_cash": 8.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine topical 2%", "drug_information": { "unit": 30.00, "type": "EA" }, "code_information": [ { "code": "00186EA0330EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.80, "discounted_cash": 40.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Budesonideeaformoterol 160 mcgea4.5 mcg/ea ea aer w/adapter [lchn]", "drug_information": { "unit": 10.20, "type": "EA" }, "code_information": [ { "code": "00186EA0370EA28", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1082.59, "discounted_cash": 1082.59, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Budesonideeaformoterol 80 mcgea4.5 mcg/ea", "drug_information": { "unit": 6.90, "type": "EA" }, "code_information": [ { "code": "00186EA0372EA28", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 537.46, "discounted_cash": 537.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol 100 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00186EA1092EA39", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.62, "discounted_cash": 8.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose 24 g/31 g gel [lchn]", "drug_information": { "unit": 31.00, "type": "EA" }, "code_information": [ { "code": "00187EA0746EA33", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.95, "discounted_cash": 8.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nitroprusside 50 mg/2 ml iv sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "00187EA4302EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 648.00, "discounted_cash": 648.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total 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Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium bicarbonate 650 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00223EA1721EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride nasal 0.65%", "drug_information": { "unit": 22.00, "type": "EA" }, "code_information": [ { "code": "00225EA0528EA48", "type": "NDC" } ], "standard_charges": [ { 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenylephrine nasal 0.25% nasal spray 15 ml [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "00225EA0800EA47", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.84, "discounted_cash": 7.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenylephrine nasal 1% nasal spray 15 ml [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "00225EA0810EA47", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.80, "discounted_cash": 8.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Potassium chloride 20 meq tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00245EA5319EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 0.9% iv sol 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "00264EA1800EA31", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna 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[lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "00264EA1800EA32", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium zirconium cyclosilicate 5 g pow [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00310EA1105EA39", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 91.93, "discounted_cash": 91.93, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Budesonideeaformoterol 160 mcgea4.5 mcg/ea ea aer w/adapter [lchn]", "drug_information": { "unit": 10.20, "type": "EA" }, "code_information": [ { "code": "00310EA7370EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 805.92, "discounted_cash": 805.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": 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"ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 0.9% iv sol 250 ml [lchn]", "drug_information": { "unit": 250.00, "type": "ML" }, "code_information": [ { "code": "00338EA0049EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 40.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", 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Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 0.9% iv sol 500 ml [lchn]", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "00338EA0049EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 50.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 0.9% iv sol 1000 ml [lchn]", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "00338EA0049EA04", "type": "NDC" } ], 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"standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lvp solution sodium chloride 0.9% sol", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "00338EA0049EA11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 0.9% iv sol 100 ml [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "00338EA0049EA48", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metronidazole 500 mg/100 ml iv sol [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "00338EA9541EA24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", 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"CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Allopurinol 300 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA0181EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA1134EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.06, "discounted_cash": 9.06, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levothyroxine 112 mcg (0.112 mg) tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA1811EA77", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Loperamide 2 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA2100EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.20, "discounted_cash": 4.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrochlorothiazideeatriamterene 25 mgea37.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA2537EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Febuxostat 80 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA3926EA93", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.60, "discounted_cash": 35.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Olanzapine 10 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA5511EA93", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 62.22, "discounted_cash": 62.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metolazone 2.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA6172EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.31, "discounted_cash": 10.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Paroxetine 20 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA7002EA93", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.93, "discounted_cash": 10.93, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nitroglycerin 0.1 mg/hr", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA9102EA93", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.43, "discounted_cash": 7.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fentanyl 12 mcg/hr", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA9119EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.40, "discounted_cash": 41.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fentanyl 50 mcg/hr", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA9122EA98", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 79.08, "discounted_cash": 79.08, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fentanyl 100 mcg/hr", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00378EA9124EA98", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 160.08, "discounted_cash": 160.08, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amoxicillin 400 mg/5 ml oral susp 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "00143EA9887EA50", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.80, "discounted_cash": 9.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": 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"payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Betamethasone dipropionate 0.05% top crm 15 gm [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "00168EA0055EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 105.66, "discounted_cash": 105.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zinc oxide 20% top oint 28 g [lchn]", "drug_information": { "unit": 28.35, "type": "EA" }, "code_information": [ { "code": "00168EA0062EA31", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.46, "discounted_cash": 6.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaineeaprilocaine 2.5%ea2.5% top crm 30 g [lchn]", "drug_information": { "unit": 30.00, "type": "EA" }, "code_information": [ { "code": "00168EA0357EA55", "type": "NDC" } ], 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fat emulsion intravenous 20% [lchn]", "drug_information": { "unit": 250.00, "type": "ML" }, "code_information": [ { "code": "00338EA0519EA09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 113.09, "discounted_cash": 113.09, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 5% with 0.45% nacl and kcl 20 meq/l iv sol 1000 ml [lchn]", "drug_information": { "unit": 1000.00, "type": "ML" }, "code_information": [ { "code": "00338EA0671EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 60.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nitroglycerin 25 mg/250 mlead5w iv 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metronidazole 500 mg/100 ml iv sol [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "00338EA1055EA48", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Verapamil 5 mg/2 ml iv sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "00409EA1144EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 70.50, "discounted_cash": 70.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicardipine 25 mg/10 ml inj sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "00143EA9689EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 61.25, "discounted_cash": 61.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 5% in water iv sol 250 ml [lchn]", "drug_information": { "unit": 250.00, "type": "ML" }, "code_information": [ { "code": "00409EA1522EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 40.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium bicarbonate 8.4% iv sol 10 ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "00409EA4900EA14", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 48.38, "discounted_cash": 48.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metronidazole 500 mg/100 ml iv sol [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "00409EA7811EA24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", 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amounts." } ] } ] }, { "description": "Hydrocortisone 1% top crm 28 g [lchn]", "drug_information": { "unit": 28.00, "type": "EA" }, "code_information": [ { "code": "00472EA0343EA56", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.96, "discounted_cash": 6.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": 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"payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ibuprofen 100 mg/5 ml oral susp [lchn]", "drug_information": { "unit": 118.00, "type": "ML" }, "code_information": [ { "code": "00472EA1764EA94", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.72, "discounted_cash": 14.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Racepinephrine 2.25% ea sol 3 ml [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00487EA5901EA99", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.50, "discounted_cash": 7.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", 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"standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium chloride 0.9%", "drug_information": { "unit": 3.00, "type": "ML" }, "code_information": [ { "code": "00487EA9301EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ipratropium 0.02% ea sol 2.5 ml [lchn]", "drug_information": { "unit": 2.50, "type": "ML" }, "code_information": [ { "code": "00487EA9801EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.28, "discounted_cash": 5.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albuterol 5 mg/ml sol", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "00487EA9901EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 27.36, "discounted_cash": 27.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetazolamide 250 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00527EA1050EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.18, "discounted_cash": 13.18, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polyethylene glycol 3350 17 g/scoop oral pwdr for recon [lchn]", "drug_information": { "unit": 17.00, "type": "EA" }, "code_information": [ { "code": "00536EA1052EA27", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicotine 7 mg/24 hr", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00536EA1106EA88", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.57, "discounted_cash": 8.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicotine 21 mg/24 hr td er film [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00536EA1108EA88", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.57, "discounted_cash": 8.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health 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4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspirin 325 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00536EA1232EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": 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"CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspirin 81 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00536EA1234EA41", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Al hydroxide/mg hydroxide/simethicone 200 mgea200 mgea20 mg/5 ml sus", "drug_information": { "unit": 360.00, "type": "ML" }, "code_information": [ { "code": "00536EA1317EA83", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.29, "discounted_cash": 15.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And 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calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicotine 4 mg loz [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00536EA1338EA09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicotine 4 mg gum [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00536EA3030EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicotine 7 mg/24 hr fil", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00536EA5894EA88", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.57, "discounted_cash": 8.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicotine 14 mg/24 hr td er film [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00536EA5895EA53", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.57, "discounted_cash": 9.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicotine 14 mg/24 hr td er film [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00536EA5895EA88", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.57, "discounted_cash": 8.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicotine 21 mg/24 hr td er film [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00536EA5896EA53", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.57, "discounted_cash": 9.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nebivolol 2.5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00456EA1402EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.90, "discounted_cash": 19.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health 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{ "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"EA" }, "code_information": [ { "code": "00469EA2601EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 51.56, "discounted_cash": 51.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nitroglycerin 50 mg/10 ml iv sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "00517EA4810EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 42.81, "discounted_cash": 42.81, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcium chloride 100 mg/ml inj sol 10 ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "00517EA6710EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 60.66, "discounted_cash": 60.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chlordiazepoxide 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00555EA0033EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Megestrol 40 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00555EA0607EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.83, "discounted_cash": 6.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ferrous gluconate 324 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00574EA0508EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Charcoaleasorbitol 25 g oral susp 120 ml [lchn]", "drug_information": { "unit": 120.00, "type": "ML" }, "code_information": [ { "code": "00574EA0520EA74", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.10, "discounted_cash": 50.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nystatin 100000 units/g top pwd 15 g [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "00574EA2008EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 54.92, "discounted_cash": 54.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Erythromycin 0.5% ophth oint 1 g [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00574EA4024EA50", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.39, "discounted_cash": 17.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspirin 300 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00574EA7034EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.83, "discounted_cash": 5.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bisacodyl 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00574EA7050EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Verapamil 80 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dicyclomine 10 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00591EA0794EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine topical 5% fil", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00591EA3525EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.08, "discounted_cash": 28.08, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Memantine 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00591EA3870EA44", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.31, "discounted_cash": 18.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Memantine 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00591EA3875EA44", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.31, "discounted_cash": 18.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tiotropium 18 mcg cap", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00597EA0075EA41", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 59.65, "discounted_cash": 59.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tiotropium 18 mcg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00597EA0075EA75", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 70.89, "discounted_cash": 70.89, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Empagliflozin 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00597EA0153EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 68.46, "discounted_cash": 68.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Empagliflozin 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00597EA0153EA37", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 71.20, "discounted_cash": 71.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dabigatran 75 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00597EA0355EA09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.76, "discounted_cash": 29.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better 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}, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lactulose 10 g/15 ml oral syrup [lchn]", "drug_information": { "unit": 236.00, "type": "ML" }, "code_information": [ { "code": "00603EA1378EA56", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 54.84, "discounted_cash": 54.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better 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amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Potassium chloride 20 meq/15 ml", "drug_information": { "unit": 473.00, "type": "ML" }, "code_information": [ { "code": "00603EA1534EA58", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 157.95, "discounted_cash": 157.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Potassium chloride 20 meq oral pwdr for recon [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00603EA1554EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.22, "discounted_cash": 32.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed 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Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine topical 5% fil", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00603EA1880EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.83, "discounted_cash": 30.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyclobenzaprine 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00603EA3078EA21", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.56, "discounted_cash": 6.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nystatin 100000 units/g top crm 30 g [lchn]", "drug_information": { "unit": 30.00, "type": "EA" }, "code_information": [ { "code": "00603EA7818EA78", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 52.50, "discounted_cash": 52.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Norepinephrine 4 mg/4 ml iv sol [lchn]", "drug_information": { "unit": 4.00, "type": "ML" }, "code_information": [ { "code": "00703EA1153EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 54.06, "discounted_cash": 54.06, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mentholeazinc oxide 0.44%ea20.6% top oint [lchn]", "drug_information": { "unit": 71.00, "type": "EA" }, "code_information": [ { "code": "00799EA0001EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.18, "discounted_cash": 8.18, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxybutynin 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00832EA0038EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxybutynin 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00832EA0038EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nystatin 100000 units/g top pwd 15 g [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "00832EA0465EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 74.92, "discounted_cash": 74.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Warfarin 2 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00832EA1212EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Warfarin 2.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00832EA1213EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Warfarin 4 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00832EA1215EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium citrate 8.85% oral liq 1.745 g/30 ml 296 ml [lchn]", "drug_information": { "unit": 296.00, "type": "ML" }, "code_information": [ { "code": "00869EA0693EA38", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.00, "discounted_cash": 5.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amitriptyline 25 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA0201EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pyridoxine 50 mg", 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium hydroxide 8%", "drug_information": { "unit": 360.00, "type": "ML" }, "code_information": [ { "code": "00904EA0788EA14", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.12, "discounted_cash": 16.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcium carbonate 500 mg chew tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA1258EA92", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ferrous gluconate 324 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA2137EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Omegaea3 polyunsaturated fatty acids 1000 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA4043EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Niacin 500 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA4342EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pseudoephedrine 30 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA5053EA59", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Simethicone 80 mg chew tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA5068EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphenhydramine 25 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA5306EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"Enalapril 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA5502EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.18, "discounted_cash": 6.18, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluoxetine 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA5784EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.68, "discounted_cash": 9.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluoxetine 20 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA5785EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.94, "discounted_cash": 9.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ibuprofen 400 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA5853EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pravastatin 20 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA5892EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.98, "discounted_cash": 9.98, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Digoxin 125 mcg (0.125 mg) tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA5921EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.74, "discounted_cash": 6.74, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clindamycin 150 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA5959EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lorazepam 0.5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6007EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"code_information": [ { "code": "00904EA6082EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Citalopram 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6084EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.71, "discounted_cash": 9.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atorvastatin 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6290EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atorvastatin 20 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6291EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clopidogrel 75 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6294EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.45, "discounted_cash": 17.45, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carvedilol 3.125 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6300EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.41, "discounted_cash": 8.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carvedilol 6.25 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6301EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.41, "discounted_cash": 8.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol 50 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6323EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.96, "discounted_cash": 4.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol 50 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6341EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levofloxacin 250 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6351EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 44.18, "discounted_cash": 44.18, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levofloxacin 500 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6352EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.46, "discounted_cash": 50.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Risperidone 0.5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6358EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.73, "discounted_cash": 15.73, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better 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}, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amlodipine 5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6370EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.57, "discounted_cash": 6.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Olanzapine 5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6377EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 39.65, "discounted_cash": 39.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tamsulosin 0.4 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6401EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.84, "discounted_cash": 16.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bisacodyl 5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6407EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Donepezil 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6408EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.35, "discounted_cash": 23.35, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": 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"EA" }, "code_information": [ { "code": "00904EA6449EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.64, "discounted_cash": 6.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Promethazine 25 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6461EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Venlafaxine 75 mg/24 hours er cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6469EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pantoprazole 40 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6474EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.34, "discounted_cash": 16.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"EA" }, "code_information": [ { "code": "00904EA6475EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lisinopril 20 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6486EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mirtazapine 15 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6519EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.44, "discounted_cash": 11.44, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Senna 8.6 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6522EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Montelukast 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6529EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.74, "discounted_cash": 16.74, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Propranolol 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6550EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trazodone 50 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6554EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Quetiapine 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6638EA61", "type": "NDC" } ], "standard_charges": [ { 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cetirizine 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6717EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Senna 8.6 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6725EA59", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetaminophen 500 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6730EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetaminophen 325 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6773EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rosuvastatin 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Montelukast 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6808EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetaminopheneahydrocodone 325 mgea5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6824EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glycerin adult supp [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00713EA0101EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glycerin pediatric", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00713EA0102EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetaminophen 120 mg supp [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00713EA0118EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prochlorperazine 25 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00713EA0135EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.77, "discounted_cash": 36.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Miconazole topical 2%", "drug_information": { "unit": 45.00, "type": "EA" }, "code_information": [ { "code": "00713EA0252EA37", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.20, "discounted_cash": 17.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrocortisone topical 25 mg sup", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00713EA0503EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 67.94, "discounted_cash": 67.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Promethazine 25 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00713EA0526EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 53.12, "discounted_cash": 53.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Promethazine 12.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00713EA0536EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 53.12, "discounted_cash": 53.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Penicillin v potassium 250 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00781EA1205EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amoxicillin 250 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00781EA2020EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amoxicillin 500 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00781EA2613EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amoxicillin 125 mg/5 ml oral susp 80 ml [lchn]", "drug_information": { "unit": 80.00, "type": "ML" }, "code_information": [ { "code": "00781EA6039EA58", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.44, "discounted_cash": 8.44, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data 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"payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metronidazole 0.75% vag gel w/appl [lchn]", "drug_information": { "unit": 70.00, "type": "EA" }, "code_information": [ { "code": "00781EA7077EA87", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 305.66, "discounted_cash": 305.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": 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}, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Spironolactone 25 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6927EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levothyroxine 50 mcg (0.05 mg) tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6950EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levothyroxine 88 mcg (0.088 mg)", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6952EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amiodarone 200 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6993EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Docusate sodium 100 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA6998EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": 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"AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amantadine 100 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7042EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.61, "discounted_cash": 8.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methocarbamol 500 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7057EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed 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"AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"code_information": [ { "code": "00904EA7109EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Buspirone 10 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7121EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Benzonatate 100 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7153EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Furosemide 20 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7177EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Furosemide 40 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7178EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better 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}, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atenolol 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7187EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Simethicone 80 mg chew tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7206EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ferrous sulfate 325 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7591EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ibuprofen 200 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7912EA59", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ibuprofen 200 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7914EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of 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"payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bisacodyl 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00904EA7927EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 0.1% ophth susp 5 ml [lchn]", "drug_information": { "unit": 5.00, "type": "EA" }, "code_information": [ { "code": "00998EA0615EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 180.98, "discounted_cash": 180.98, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bismuth subsalicylate 262 mg/15 ml", "drug_information": { "unit": 240.00, "type": "ML" }, "code_information": [ { "code": "01490EA0390EA08", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.04, "discounted_cash": 12.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Silver topical ea gel [lchn]", "drug_information": { "unit": 45.00, "type": "ML" }, "code_information": [ { "code": "08327EA0309EA09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 61.12, "discounted_cash": 61.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thiamine 50 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "10006EA0730EA19", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium oxide 400 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "10006EA0730EA38", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Scopolamine 1 mg (1 mg/72 hr) td er film [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "10019EA0553EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 76.67, "discounted_cash": 76.67, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rocuronium 100 mg/10 ml iv sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "10139EA0235EA11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": 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[lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "11534EA0166EA44", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenobarbital 60 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "16571EA0674EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gemfibrozil 600 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "16571EA0784EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.72, "discounted_cash": 9.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Loratadine 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "16571EA0822EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Simvastatin 20 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "16729EA0005EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.61, "discounted_cash": 19.61, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Naltrexone 50 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "16729EA0081EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.08, "discounted_cash": 17.08, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed 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Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Buspirone 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "16729EA0200EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Doxazosin 2 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "16729EA0414EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.39, "discounted_cash": 5.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": 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"standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Olanzapine 10 mg im inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "00781EA3159EA72", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 83.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine 1% ophth sol 2 ml [lchn]", "drug_information": { "unit": 2.00, "type": "EA" }, "code_information": [ { "code": "17478EA0215EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 46.70, "discounted_cash": 46.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." 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"type": "EA" }, "code_information": [ { "code": "20555EA0036EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Melatonin 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "20555EA0039EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Indomethacin 25 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "23155EA0010EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better 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}, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Buspirone 5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "23155EA0023EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glyburide 5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "23155EA0058EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metformin 500 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "23155EA0102EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nifedipine 10 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "23155EA0194EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetazolamide 250 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "23155EA0288EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.53, "discounted_cash": 11.53, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tranexamic acid 1000 mg/10 ml iv sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "23155EA0524EA41", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 173.58, "discounted_cash": 173.58, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neomycin/polymyxin b/hydrocortisone otic susp 10 ml [lchn]", "drug_information": { "unit": 10.00, "type": "EA" }, "code_information": [ { "code": "24208EA0635EA62", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 341.30, "discounted_cash": 341.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium sulfacetamide 10% ophth sol 15 ml [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "24208EA0670EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 122.00, "discounted_cash": 122.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bacitracin/neomycin/polymyxin b ophthalmic 400 unitsea3.5 mgea10000 units/g", "drug_information": { "unit": 3.50, "type": "EA" }, "code_information": [ { "code": "24208EA0780EA55", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 170.85, "discounted_cash": 170.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", 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"plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And 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remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone/neomycin/polymyxin b ophth susp 5 ml [lchn]", "drug_information": { "unit": 5.00, "type": "EA" }, "code_information": [ { "code": "24208EA0830EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 39.72, "discounted_cash": 39.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Erythromycin 0.5% ophth oint 1 g [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "24208EA0910EA19", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.83, "discounted_cash": 24.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"ML" }, "code_information": [ { "code": "24338EA0134EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 902.92, "discounted_cash": 902.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Risperidone 2 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "27241EA0004EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.82, "discounted_cash": 22.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Risperidone 4 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "27241EA0006EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 36.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Folic acid 5 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "39822EA1100EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ethacrynic acid 50 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "42023EA0157EA99", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6384.00, "discounted_cash": 6384.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydralazine 25 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "31722EA0520EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lithium 300 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "31722EA0545EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vasopressin 20 units/100 ml d5w premix [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "42023EA0237EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 509.70, "discounted_cash": 509.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Memantine 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "42292EA0006EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.31, "discounted_cash": 18.31, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fenofibrate 160 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "42385EA0936EA90", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrocortisone topical 25 mg sup", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "42494EA0301EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 68.00, "discounted_cash": 68.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxycodone 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "42858EA0001EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxycodone 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "42858EA0001EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Misoprostol 100 mcg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "43386EA0160EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ropinirole 2 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "43547EA0271EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.00, "discounted_cash": 10.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Donepezil 5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "43547EA0275EA09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 25.97, "discounted_cash": 25.97, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amoxicillineaclavulanate 875 mgea125 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "42571EA0162EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.15, "discounted_cash": 15.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol 1 mg/ml", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "36000EA0033EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nitroglycerin 0.4 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "43598EA0436EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrocortisone 2.5% top crm 28 g [lchn]", "drug_information": { "unit": 28.00, "type": "EA" }, "code_information": [ { "code": "45802EA0004EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.60, "discounted_cash": 21.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nystatin topical 100000 units/g cre", "drug_information": { "unit": 30.00, "type": "EA" }, "code_information": [ { "code": "45802EA0059EA35", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bacitracin 500 units/g top oint 0.9 gm [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "45802EA0060EA70", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Triamcinolone 0.1% top crm 80 g [lchn]", "drug_information": { "unit": 80.00, "type": "EA" }, "code_information": [ { "code": "45802EA0064EA35", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.49, "discounted_cash": 41.49, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mupirocin 2% top oint 22 g [lchn]", "drug_information": { "unit": 22.00, "type": "EA" }, "code_information": [ { "code": "45802EA0112EA22", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.90, "discounted_cash": 22.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metronidazole 0.75% vag gel w/appl [lchn]", "drug_information": { "unit": 70.00, "type": "EA" }, "code_information": [ { "code": "45802EA0139EA70", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 305.66, "discounted_cash": 305.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"Oxymetazoline 0.05% nasal spray 30 ml [lchn]", "drug_information": { "unit": 30.00, "type": "EA" }, "code_information": [ { "code": "45802EA0410EA59", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.98, "discounted_cash": 7.98, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fentanyl 25 mcg/hr", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "47781EA0424EA47", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 63.80, "discounted_cash": 63.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oseltamivir 75 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "47781EA0470EA13", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 46.37, "discounted_cash": 46.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin 125 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "47781EA0729EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 93.92, "discounted_cash": 93.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 4 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "47781EA0914EA51", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.82, "discounted_cash": 4.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Influenza virus vaccine inactivated higheadose pf quadrivalent im susp [lchn]", "drug_information": { "unit": 0.70, "type": "ML" }, "code_information": [ { "code": "49281EA0122EA65", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 147.24, "discounted_cash": 147.24, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tetanuseadiphth toxoids (td) adult/adol 5 unitsea2 units/0.5 ml pf im sus [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "49281EA0215EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 135.60, "discounted_cash": 135.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Influenza virus vaccine inactivated pf quadrivalent im susp [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "49281EA0422EA50", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 57.78, "discounted_cash": 57.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphtheria/pertussisacel/tetanus/polio im susp [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "49281EA0562EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 208.29, "discounted_cash": 208.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphtheria/pertussisacel/tetanus/polio ea sus prefilled [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "49281EA0564EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 296.19, "discounted_cash": 296.19, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspirin 81 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "49483EA0481EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Imipramine 25 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "49884EA0055EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alprazolam 0.5 mg dis tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "49884EA0111EA52", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.56, "discounted_cash": 7.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cholestyramine 4 g/9 g", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "49884EA0465EA65", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.48, "discounted_cash": 13.48, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Digoxin 125 mcg (0.125 mg)", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "49884EA0514EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.20, "discounted_cash": 9.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of 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"AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"code_information": [ { "code": "50111EA0467EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Propranolol 40 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50111EA0469EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Torsemide 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50111EA0916EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fludrocortisone 0.1 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50268EA0330EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.39, "discounted_cash": 6.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glimepiride 4 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50268EA0360EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.88, "discounted_cash": 4.88, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Indomethacin 25 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50268EA0430EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Losartan 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50268EA0504EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nifedipine 10 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50268EA0600EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.85, "discounted_cash": 7.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluticasone 0.05 mg/ea nasal spray 16 g [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50383EA0700EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.54, "discounted_cash": 10.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albuterol 5 mg/ml", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "50383EA0741EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 173.85, "discounted_cash": 173.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine topical 2% sol [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "50383EA0775EA04", "type": "NDC" } ], "standard_charges": [ { 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"standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine topical 2% sol ud 15 ml [lchn]", "drug_information": { "unit": 15.00, "type": "ML" }, "code_information": [ { "code": "50383EA0775EA17", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.32, "discounted_cash": 4.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lactulose 10 g/15 ml oral syrup [lchn]", "drug_information": { "unit": 236.00, "type": "ML" }, "code_information": [ { "code": "50383EA0779EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 53.84, "discounted_cash": 53.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rivaroxaban 15 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50458EA0578EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 62.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rivaroxaban 10 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50458EA0580EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 62.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rivaroxaban 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50458EA0580EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 62.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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[lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "50632EA0010EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 818.73, "discounted_cash": 818.73, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pantoprazole 40 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0051EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.80, "discounted_cash": 15.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Furosemide 20 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0072EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Furosemide 40 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0073EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sulfamethoxazoleeatrimethoprim 800 mgea160 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0128EA08", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.32, "discounted_cash": 7.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ciprofloxacin 500 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0182EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.30, "discounted_cash": 15.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Allopurinol 100 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0205EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Allopurinol 300 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0206EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Loratadine 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0246EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol tartrate 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0255EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diazepam 5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0285EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carbamazepine 200 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0385EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.40, "discounted_cash": 6.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nifedipine 30 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0400EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.30, "discounted_cash": 5.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Temazepam 15 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0418EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Doxepin 25 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0437EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levothyroxine 50 mcg (0.05 mg) tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0440EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levothyroxine 25 mcg (0.025 mg) tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0444EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Midodrine 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0453EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.84, "discounted_cash": 10.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cetirizine 10 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0597EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.98, "discounted_cash": 9.98, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atenolol 50 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0684EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Loperamide 2 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0690EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zolpidem 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0724EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.48, "discounted_cash": 18.48, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Haloperidol 0.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0733EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Haloperidol 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0736EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.37, "discounted_cash": 4.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diltiazem 30 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0745EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atenolol 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0759EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol 50 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0801EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levetiracetam 500 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0821EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.06, "discounted_cash": 14.06, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clonazepam 0.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0881EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Verapamil 180 mg/12 hours", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0899EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.97, "discounted_cash": 9.97, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Labetalol 100 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0928EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enalapril 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0951EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.41, "discounted_cash": 7.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Buspirone 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0986EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.38, "discounted_cash": 5.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tramadol 50 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51079EA0991EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Benzonatate 100 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51224EA0010EA50", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.01, "discounted_cash": 10.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenazopyridine 100 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51293EA0810EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.80, "discounted_cash": 10.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium polystyrene sulfonate pwdr [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51293EA0831EA97", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hyoscyamine 0.125 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51525EA0112EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": 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"ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nystatineatriamcinolone top crm 15 g [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "51672EA1263EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 223.88, "discounted_cash": 223.88, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mupirocin 2% top oint 22 g [lchn]", "drug_information": { "unit": 22.00, "type": "EA" }, "code_information": [ { "code": "51672EA1312EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 50.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clotrimazole 1% top crm 30 gm [lchn]", "drug_information": { "unit": 30.00, "type": "EA" }, "code_information": [ { "code": "51672EA2002EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 22.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", 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"standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrocortisone 2.5% top crm 28 g [lchn]", "drug_information": { "unit": 28.00, "type": "EA" }, "code_information": [ { "code": "51672EA3003EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.10, "discounted_cash": 19.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amiodarone 200 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51672EA4025EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.21, "discounted_cash": 13.21, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carbamazepine 100 mg/5 ml oral susp 450 ml [lchn]", "drug_information": { "unit": 450.00, "type": "ML" }, "code_information": [ { "code": "51672EA4047EA09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 265.77, "discounted_cash": 265.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Promethazine 12.5 mg sup", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "51672EA5296EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 53.12, "discounted_cash": 53.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polyethylene glycol 3350 17 g/scoop oral pwdr for recon [lchn]", "drug_information": { "unit": 17.00, "type": "EA" }, "code_information": [ { "code": "51991EA0961EA58", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Theophylline 100 mg/24 hours", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "52244EA0100EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.99, "discounted_cash": 13.99, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine 5% top oint 35 g[lchn]", "drug_information": { "unit": 35.44, "type": "EA" }, "code_information": [ { "code": "52565EA0008EA14", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 633.32, "discounted_cash": 633.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Folic acid 1 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "53746EA0361EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meclizine 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "53746EA0442EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Spironolactone 25 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "53746EA0511EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Primidone 50 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "53746EA0544EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Flecainide 50 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "53746EA0641EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.24, "discounted_cash": 10.24, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Niacin 50 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "54629EA0051EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ascorbic acid 1000 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "54629EA0093EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atorvastatin 20 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "55111EA0122EA90", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.48, "discounted_cash": 16.48, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "55111EA0466EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.22, "discounted_cash": 4.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better 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}, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Divalproex sodium 125 mg sprinkle ec cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "55111EA0532EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.48, "discounted_cash": 4.48, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Influenza virus vaccine inactivated pf quadrivalent im susp 5 ml [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "49281EA0637EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 431.20, "discounted_cash": 431.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esomeprazole 40 mg", "drug_information": { "unit": 10.00, "type": "EA" }, "code_information": [ { "code": "55150EA0185EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1080.00, "discounted_cash": 1080.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vecuronium 20 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "55150EA0236EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 33.75, "discounted_cash": 33.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Olanzapine 10 mg im inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "55150EA0308EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 85.06, "discounted_cash": 85.06, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluconazole 100 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "57237EA0004EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.26, "discounted_cash": 26.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Duloxetine 30 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "57237EA0018EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.56, "discounted_cash": 23.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Duloxetine 30 mg cap", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "57237EA0018EA90", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.55, "discounted_cash": 23.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amoxicillin 500 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, 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"Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Penicillin v potassium 250 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "57237EA0040EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clarithromycin 500 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "57237EA0045EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.08, "discounted_cash": 18.08, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of 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"FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium hydroxide 8% sus", "drug_information": { "unit": 360.00, "type": "ML" }, "code_information": [ { "code": "57896EA0649EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.36, "discounted_cash": 8.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspirin 81 mg chew tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "57896EA0911EA36", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rotavirus vaccine monovalent liq [lchn]", "drug_information": { "unit": 1.50, "type": "ML" }, "code_information": [ { "code": "58160EA0740EA21", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 331.18, "discounted_cash": 331.18, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphtheria/pertussisacel/tetanus/polio im susp [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "58160EA0812EA52", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 204.19, "discounted_cash": 204.19, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis b adult vaccine 20 mcg/ml im susp vial [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "58160EA0821EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 222.69, "discounted_cash": 222.69, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meningococcal oligosaccharide 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dicyclomine 10 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "58914EA0012EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrocortisone topical 25 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "59741EA0301EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.40, "discounted_cash": 41.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sertraline 50 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "59762EA4900EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Misoprostol 100 mcg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "59762EA5007EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine 1% ophth sol 2 ml [lchn]", "drug_information": { "unit": 2.00, "type": "EA" }, "code_information": [ { "code": "60219EA1748EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 95.72, "discounted_cash": 95.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium nitriteeasodium thiosulfate 30 mgea250 mg/ml 60 ml[lchn]", "drug_information": { "unit": 60.00, "type": "ML" }, "code_information": [ { "code": "60267EA0812EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 367.20, "discounted_cash": 367.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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[lchn]", "drug_information": { "unit": 473.00, "type": "ML" }, "code_information": [ { "code": "60432EA0606EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 138.00, "discounted_cash": 138.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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20.77, "discounted_cash": 20.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": 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"Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxycodone 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "59011EA0410EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.22, "discounted_cash": 17.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", 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90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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}, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sertraline 50 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0242EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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"Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rosuvastatin 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0245EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.43, "discounted_cash": 21.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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}, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bumetanide 1 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0384EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.19, "discounted_cash": 5.19, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol 50 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0402EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.46, "discounted_cash": 4.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"type": "EA" }, "code_information": [ { "code": "60687EA0433EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trazodone 50 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0443EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ibuprofen 400 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0446EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better 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}, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydromorphone 4 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0590EA01", "type": "NDC" } ], "standard_charges": [ { 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gabapentin 300 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0591EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.51, "discounted_cash": 5.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metformin 500 mg er tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0640EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gentamicin 0.3% ophth sol 5 ml [lchn]", "drug_information": { "unit": 5.00, "type": "EA" }, "code_information": [ { "code": "61314EA0633EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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] }, { "description": "Glimepiride 4 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "61442EA0117EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.86, "discounted_cash": 4.86, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": 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"payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Silver sulfadiazine topical 1%", "drug_information": { "unit": 400.00, "type": "EA" }, "code_information": [ { "code": "61570EA0131EA40", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 142.00, "discounted_cash": 142.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Multiple vitamins iv sol 10 ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "61703EA0422EA82", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 37.05, "discounted_cash": 37.05, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", 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"standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Isosorbide mononitrate 20 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "62175EA0107EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Modafinil 200 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "62332EA0386EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 100.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nebivolol 2.5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "62559EA0275EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.04, "discounted_cash": 17.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Indapamide 2.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "62559EA0511EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.20, "discounted_cash": 6.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fentanyl 100 mcg/hr fil", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60505EA7084EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 236.14, "discounted_cash": 236.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nicotine 14 mg/24 hr td er film [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60505EA7089EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.14, "discounted_cash": 9.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clonidine 0.1 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0113EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sumatriptan 25 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63304EA0097EA19", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 84.75, "discounted_cash": 84.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clindamycin 150 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63304EA0692EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.77, "discounted_cash": 4.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clindamycin 300 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63304EA0693EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 14.87, "discounted_cash": 14.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cephalexin 250 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0152EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cephalexin 500 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0163EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.41, "discounted_cash": 5.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diltiazem 120 mg/24 hours cap", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0195EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diltiazem 180 mg/24 hours cap", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "60687EA0206EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium bicarbonate 4.2%", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "63323EA0083EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 61.92, "discounted_cash": 61.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Doxycycline 100 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63323EA0130EA11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 57.98, "discounted_cash": 57.98, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Folic acid 5 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "63323EA0184EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diclofenac 1% top gel [lchn]", "drug_information": { "unit": 100.00, "type": "EA" }, "code_information": [ { "code": "63481EA0684EA47", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 129.64, "discounted_cash": 129.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chlorhexidine topical 0.12% liq", "drug_information": { "unit": 473.00, "type": "ML" }, "code_information": [ { "code": "63739EA0052EA69", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 128.38, "discounted_cash": 128.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diazepam 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0073EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glyburide 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0119EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better 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}, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydralazine 25 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0126EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Promethazine 25 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0213EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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}, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levetiracetam 500 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0411EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lorazepam 0.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0499EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"type": "EA" }, "code_information": [ { "code": "63739EA0531EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Simvastatin 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0571EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Simvastatin 20 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0572EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Famotidine 20 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0645EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Losartan 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0673EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ciprofloxacin 250 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0700EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of 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"AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed 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"standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gabapentin 100 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0902EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Potassium chloride 20 meq", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63739EA0973EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Guaifenesin 600 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "63824EA0008EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health 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{ "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetylcysteine 20% ea sol 10 ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "63323EA0692EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.16, "discounted_cash": 29.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", 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amounts." } ] } ] }, { "description": "Naproxen 250 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65162EA0188EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total 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"payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lidocaine 5% top film [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65162EA0791EA08", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.83, "discounted_cash": 30.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aripiprazole 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65162EA0897EA03", "type": "NDC" } ], "standard_charges": [ { 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sulfamethoxazoleeatrimethoprim 400 mgea80 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65862EA0419EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sulfamethoxazoleeatrimethoprim 200 mgea40 mg/5 ml", "drug_information": { "unit": 473.00, "type": "ML" }, "code_information": [ { "code": "65862EA0496EA47", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 430.80, "discounted_cash": 430.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of 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"payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amoxicillineaclavulanate 875 mgea125 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65862EA0503EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.80, "discounted_cash": 19.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Venlafaxine 37.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65862EA0527EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.65, "discounted_cash": 16.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Venlafaxine 75 mg/24 hours er cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65862EA0528EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.66, "discounted_cash": 18.66, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rivastigmine 1.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65862EA0648EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.65, "discounted_cash": 18.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefuroxime 500 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65862EA0700EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amoxicillineaclavulanate 200 mgea28.5 mg/5 ml oral susp 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "66685EA1011EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.90, "discounted_cash": 36.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total 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Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amoxicillineaclavulanate 400 mgea57 mg/5 ml oral susp 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "66685EA1012EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 70.30, "discounted_cash": 70.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nystatin 500000 units/5 ml oral susp [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "66689EA0037EA50", "type": "NDC" } ], 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"standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine/hyoscyamine/phenobarbital/scopolamine 16.2 mg/5 ml oral elix 120 ml [lchn]", "drug_information": { "unit": 120.00, "type": "ML" }, "code_information": [ { "code": "66689EA0063EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2313.36, "discounted_cash": 2313.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albuterol cfc free 90 mcg/ea ea aer w/adapt [lchn]", "drug_information": { "unit": 18.00, "type": "EA" }, "code_information": [ { "code": "66993EA0019EA68", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 124.88, "discounted_cash": 124.88, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed 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"Amoxicillin 250 mg/5 ml oral susp 80 ml [lchn]", "drug_information": { "unit": 80.00, "type": "ML" }, "code_information": [ { "code": "67253EA0148EA45", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10.84, "discounted_cash": 10.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acyclovir 800 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0109EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.20, "discounted_cash": 18.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Omeprazole 20 mg ec cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0128EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.46, "discounted_cash": 4.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Benzonatate 100 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0214EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fludrocortisone 0.1 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0288EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.22, "discounted_cash": 4.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tamsulosin 0.4 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0299EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.85, "discounted_cash": 16.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lamotrigine 25 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0318EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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"Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of 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"AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sotalol 80 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0497EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pravastatin 20 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0501EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 13.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Guaifenesin 600 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0572EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.01, "discounted_cash": 4.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Isosorbide mononitrate 30 mg er tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0591EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.71, "discounted_cash": 6.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Duloxetine 30 mg cap", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0683EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.10, "discounted_cash": 23.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Olanzapine 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0723EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.67, "discounted_cash": 32.67, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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}, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Doxazosin 2 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0851EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.37, "discounted_cash": 4.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Montelukast 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68084EA0875EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.52, "discounted_cash": 16.52, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphenhydramine 12.5 mg/5 ml oral liq 5 ml [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "68094EA0022EA62", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7.68, "discounted_cash": 7.68, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Melatonin 3 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68094EA0110EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better 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}, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetaminophen 160 mg/5 ml oral susp [lchn]", "drug_information": { "unit": 118.00, "type": "ML" }, "code_information": [ { "code": "68094EA0231EA62", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 71.53, "discounted_cash": 71.53, "setting": "both", "payers_information": [ { "payer_name": "Aetna 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nystatin 500000 units/5 ml oral 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn 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billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin 125 mg cap", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68180EA0166EA13", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 93.92, "discounted_cash": 93.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bupropion 150 mg/24 hours er tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68180EA0319EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.09, "discounted_cash": 19.09, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bupropion 300 mg/24 hours er tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68180EA0320EA09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 19.07, "discounted_cash": 19.07, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nystatin 100000 units/g top pwd 15 g [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "68308EA0152EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43.90, "discounted_cash": 43.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Risperidone 0.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68382EA0113EA14", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.12, "discounted_cash": 17.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diltiazem 180 mg/24 hours", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68382EA0596EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.78, "discounted_cash": 5.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluconazole 100 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68462EA0102EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.41, "discounted_cash": 26.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rifaximin 550 mg tab ud [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65649EA0303EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 189.59, "discounted_cash": 189.59, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefpodoxime 200 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65862EA0096EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 25.37, "discounted_cash": 25.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sumatriptan 25 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65862EA0146EA36", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 81.16, "discounted_cash": 81.16, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefdinir 300 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65862EA0177EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 15.32, "discounted_cash": 15.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clindamycin 150 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "65862EA0185EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.77, "discounted_cash": 4.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefdinir 125 mg/5 ml oral susp 60 ml [lchn]", "drug_information": { "unit": 60.00, "type": "ML" }, "code_information": [ { "code": "65862EA0218EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 101.90, "discounted_cash": 101.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefdinir 250 mg/5 ml oral susp 60 ml [lchn]", "drug_information": { "unit": 60.00, "type": "ML" }, "code_information": [ { "code": "65862EA0219EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 198.70, "discounted_cash": 198.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium oxide 400 mg tab [lchn]", 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alendronate 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "64980EA0340EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11.69, "discounted_cash": 11.69, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketamine 500 mg/10 ml inj sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "67457EA0001EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.94, "discounted_cash": 21.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health 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"discounted_cash": 48.87, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of 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"payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nitroprusside 50 mg/2 ml iv sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "67457EA0839EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 582.55, "discounted_cash": 582.55, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cephalexin 250 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "67877EA0220EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"EA" }, "code_information": [ { "code": "67877EA0251EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 62.19, "discounted_cash": 62.19, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Triamcinolone 0.1% top crm 80 g [lchn]", "drug_information": { "unit": 80.00, "type": "EA" }, "code_information": [ { "code": "67877EA0251EA80", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.10, "discounted_cash": 29.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Linezolid 600 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "67877EA0419EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 367.33, "discounted_cash": 367.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atorvastatin 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "67877EA0511EA90", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.20, "discounted_cash": 16.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atorvastatin 20 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "67877EA0512EA90", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 16.48, "discounted_cash": 16.48, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefdinir 125 mg/5 ml oral susp 60 ml [lchn]", "drug_information": { "unit": 60.00, "type": "ML" }, "code_information": [ { "code": "67877EA0547EA98", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 101.80, "discounted_cash": 101.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Naproxen 250 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68462EA0188EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rosuvastatin 10 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68462EA0262EA90", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.83, "discounted_cash": 26.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health 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{ "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Verapamil 180 mg/12 hours tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68462EA0293EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.76, "discounted_cash": 5.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Indomethacin 25 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68462EA0406EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diltiazem 30 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "68682EA0006EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tetracaine 0.5% ophth sol [lchn]", "drug_information": { "unit": 15.00, "type": "EA" }, "code_information": [ { "code": "68682EA0920EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 216.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better 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amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amlodipine 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "69097EA0127EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6.92, "discounted_cash": 6.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amlodipine 10 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "69097EA0128EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.50, "discounted_cash": 9.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albuterol cfc free 90 mcg/ea ea aer w/adapt [lchn]", "drug_information": { "unit": 18.00, "type": "EA" }, "code_information": [ { "code": "69097EA0142EA60", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 397.72, "discounted_cash": 397.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyclobenzaprine 5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "69097EA0845EA07", "type": "NDC" } ], "standard_charges": [ { 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyclobenzaprine 10 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "69097EA0846EA07", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.63, "discounted_cash": 4.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Doxycycline hyclate 100 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "69238EA1100EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.85, "discounted_cash": 28.85, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": 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{ "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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1.00, "type": "EA" }, "code_information": [ { "code": "69238EA1617EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.22, "discounted_cash": 32.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mineral oil 100% oral liq 480 ml [lchn]", "drug_information": { "unit": 480.00, "type": "ML" }, "code_information": [ { "code": "70000EA0448EA01", "type": "NDC" } ], 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetaminophen 160 mg/5 ml oral susp [lchn]", "drug_information": { "unit": 118.00, "type": "ML" }, "code_information": [ { "code": "70000EA0496EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.37, "discounted_cash": 17.37, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": 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"AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methocarbamol 750 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "70010EA0770EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", 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"Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sulfamethoxazoleeatrimethoprim 80 mgea16 mg/ml iv sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "70069EA0362EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 38.01, "discounted_cash": 38.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nitroprusside 50 mg/2 ml iv sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "70121EA1189EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 58.80, "discounted_cash": 58.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Norepinephrine 4 mg/4 ml iv sol [lchn]", "drug_information": { "unit": 4.00, "type": "ML" }, "code_information": [ { "code": "70121EA1576EA07", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 54.06, "discounted_cash": 54.06, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hyoscyamine 0.125 mg", 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol 25 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "70436EA0202EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.04, "discounted_cash": 5.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluconazole 100 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "70710EA1138EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 26.26, "discounted_cash": 26.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed 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75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fenofibrate 160 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "70756EA0215EA90", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.51, "discounted_cash": 9.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Verapamil 5 mg/2 ml iv sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "70756EA0605EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 31.25, "discounted_cash": 31.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": 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"CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Emollients top crm 454 g [lchn]", "drug_information": { "unit": 454.00, "type": "EA" }, "code_information": [ { "code": "72140EA0002EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.88, "discounted_cash": 22.88, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Febuxostat 40 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "72205EA0028EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.20, "discounted_cash": 30.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Celecoxib 100 mg cap [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "72241EA0023EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 18.46, "discounted_cash": 18.46, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tranexamic acid 1000 mg/10 ml iv sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "72485EA0107EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.50, "discounted_cash": 34.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": 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"plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Verapamil 5 mg/2 ml iv sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "72485EA0108EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 31.23, "discounted_cash": 31.23, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoprolol tartrate 1 mg/ml inj sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "72611EA0740EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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}, "code_information": [ { "code": "72611EA0757EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.25, "discounted_cash": 34.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tranexamic acid 1000 mg/10 ml iv sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "72611EA0760EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Valsartan 80 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "72819EA0182EA09", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenazopyridine 100 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "75826EA0114EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 9.60, "discounted_cash": 9.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine/hyoscyamine/phenobarbital/scopolamine 16.2 mg/5 ml oral elix 120 ml [lchn]", "drug_information": { "unit": 120.00, "type": "ML" }, "code_information": [ { "code": "75826EA0128EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 650.93, "discounted_cash": 650.93, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levalbuterol 1.25 mg/3 ml", "drug_information": { "unit": 3.00, "type": "ML" }, "code_information": [ { "code": "76204EA0900EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 8.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levalbuterol 1.25 mg/3 ml sol", "drug_information": { "unit": 3.00, "type": "ML" }, "code_information": [ { "code": "76204EA0900EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.00, "discounted_cash": 8.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcium chloride 100 mg/ml inj sol 10 ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "76329EA3304EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 31.50, "discounted_cash": 31.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cyanocobalamin 1000 mcg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "77333EA0938EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cholecalciferol 25 mcg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "79854EA0050EA24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2.00, "discounted_cash": 2.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Multivitamin therapeutic multiple vitamins", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "80681EA0003EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "99999EA9999EA99", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "10021 fine needle aspiration w/o imaging guidance techfee", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fna bx w/o img gdn 1st les", "code_information": [ { "code": "10021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "10040 extraction marsupialization cysts pustules", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acne surgery", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13099.00, "discounted_cash": 13099.00, "minimum": 204.22, "maximum": 214.97, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acne surgery", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "outpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "10060 i & d abscess simple/single", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 619.00, "discounted_cash": 619.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "1 through 10", "median_amount": 72.47, "10th_percentile": 55.87, "90th_percentile": 89.06, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of skin abscess", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13099.00, "discounted_cash": 13099.00, "minimum": 204.22, "maximum": 214.97, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "1 through 10", "median_amount": 72.47, "10th_percentile": 55.87, "90th_percentile": 89.06, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of skin abscess", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 619.00, "discounted_cash": 619.00, "minimum": 204.22, "maximum": 214.97, "setting": "outpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "1 through 10", "median_amount": 72.47, "10th_percentile": 55.87, "90th_percentile": 89.06, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "10061 i & d abscess complicated/multiple", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of skin abscess", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13099.00, "discounted_cash": 13099.00, "minimum": 410.64, "maximum": 432.25, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of skin abscess", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "outpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "10080 i & d pilonidal cyst simple", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of pilonidal cyst", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "10081 incision & drainage pilonidal cyst complicated techfee", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of pilonidal cyst", "code_information": [ { "code": "10081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4485.50, "discounted_cash": 4485.50, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "10121 incision & removal foreign body subq tiss compl techfee", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4726.00, "discounted_cash": 4726.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body", "code_information": [ { "code": "10121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4726.00, "discounted_cash": 4726.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "10140 i & d hematoma seroma/fluid collection", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4726.00, "discounted_cash": 4726.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of hematoma/fluid", "code_information": [ { "code": "10140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4726.00, "discounted_cash": 4726.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "10160 puncture aspiration abscess hematoma bulla/cyst techfee", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Puncture drainage of lesion", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "10180 incision and drainage complex postoperative wound infection techfee", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7983.00, "discounted_cash": 7983.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complex drainage wound", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7983.00, "discounted_cash": 7983.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11000 dbrdmt extensv eczema/infect skn up 10% bdy surf", "code_information": [ { "code": "11000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride infected skin", "code_information": [ { "code": "11000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11010 dbrdmt w/rmvl fm fx&/dislc skin&subq tissus techfee", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2142.00, "discounted_cash": 2142.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride skin at fx site", "code_information": [ { "code": "11010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2142.00, "discounted_cash": 2142.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb skin bone at fx site", "code_information": [ { "code": "11012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "minimum": 2941.61, "maximum": 3096.43, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11042 debridement sucutaneous tissue", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1188.00, "discounted_cash": 1188.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb subq tissue 20 sq cm/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1188.00, "discounted_cash": 1188.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb bone 20 sq cm/<", "code_information": [ { "code": "11044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "minimum": 1665.28, "maximum": 1752.92, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Deb bone add-on", "code_information": [ { "code": "11047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11102 tangential biopsy of skin single lesion", "code_information": [ { "code": "11102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 57.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "1 through 10", "median_amount": 29.23, "10th_percentile": 24.25, "90th_percentile": 33.13, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tangntl bx skin single les", "code_information": [ { "code": "11102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 57.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "1 through 10", "median_amount": 29.23, "10th_percentile": 24.25, "90th_percentile": 33.13, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11103 tangential biopsy of skin. ea addtl lesion", "code_information": [ { "code": "11103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tangntl bx skin ea sep/addl", "code_information": [ { "code": "11103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11104 punch biopsy skin single lesion", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Punch bx skin single lesion", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11105 punch biopsy skin ea addtl lesion", "code_information": [ { "code": "11105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 38.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Punch bx skin ea sep/addl", "code_information": [ { "code": "11105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 38.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc tr-ext b9+marg >4.0 cm", "code_information": [ { "code": "11406", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4198.00, "discounted_cash": 4198.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4727.00, "discounted_cash": 4727.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 2.1-3", "code_information": [ { "code": "11423", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4727.00, "discounted_cash": 4727.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp b9+marg 3.1-4", "code_information": [ { "code": "11424", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18766.00, "discounted_cash": 18766.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc face-mm b9+marg 1.1-2 cm", "code_information": [ { "code": "11442", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28004.50, "discounted_cash": 28004.50, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11462 exc skin/subcu tissue for hidradenitis inguinal; w/simple or interm repair", "code_information": [ { "code": "11462", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8222.00, "discounted_cash": 8222.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal sweat gland lesion", "code_information": [ { "code": "11462", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8222.00, "discounted_cash": 8222.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc h-f-nk-sp mal+marg 0.5/<", "code_information": [ { "code": "11620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22082.67, "discounted_cash": 22082.67, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc s/n/h/f/g mal+mrg >4 cm", "code_information": [ { "code": "11626", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4270.00, "discounted_cash": 4270.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc f/e/e/n/l mal+mrg 1.1-2", "code_information": [ { "code": "11642", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4222.00, "discounted_cash": 4222.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc f/e/e/n/l mal+mrg 2.1-3", "code_information": [ { "code": "11643", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9811.31, "discounted_cash": 9811.31, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11644 excision malignant lesion face ears eyelids nose lips 3.1cm to 4.0cm", "code_information": [ { "code": "11644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4773.00, "discounted_cash": 4773.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc f/e/e/n/l mal+mrg 3.1-4", "code_information": [ { "code": "11644", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4773.00, "discounted_cash": 4773.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc f/e/e/n/l mal+mrg >4 cm", "code_information": [ { "code": "11646", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4474.00, "discounted_cash": 4474.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11720 debridement nail any method 1-5 techfee", "code_information": [ { "code": "11720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 193.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride nail 1-5", "code_information": [ { "code": "11720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 193.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11721 debridement nail any method 6 or greater", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 193.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Debride nail 6 or more", "code_information": [ { "code": "11721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 193.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11730 avulsion nail plate partial/complete simple 1 techfee", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of nail plate", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11732 avulsion of nail plate partial or complete simple; each ad techfee", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 582.00, "discounted_cash": 582.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove nail plate add-on", "code_information": [ { "code": "11732", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 582.00, "discounted_cash": 582.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11740 evacuation subungual hematoma techfee", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain blood from under nail", "code_information": [ { "code": "11740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11750 excision nail matrix permanent removal techfee", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of nail bed", "code_information": [ { "code": "11750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11760 repair nail bed", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of nail bed", "code_information": [ { "code": "11760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "11765 wedge excision skin nail fold techfee", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excision of nail fold toe", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12001 simple repair of superficial wounds of scalp neck axillae external genitalia trunk and/or", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "1 through 10", "median_amount": 268.99, "10th_percentile": 268.99, "90th_percentile": 268.99, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/ax/gen/trnk 2.5cm/<", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "1 through 10", "median_amount": 268.99, "10th_percentile": 268.99, "90th_percentile": 268.99, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12002 smpl repair scalp/neck/ax/genit/trunk 2.6-7.5cm techfee", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/ax/gen/trnk2.6-7.5cm", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12004 simple rpr scalp/neck/ax/genit/trunk 7.6-12.5cm techfee", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/ax/gen/trk7.6-12.5cm", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12005 smpl rpr scalp/neck/ax/genit/trunk 12.6-20.0cm techfee", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/a/gen/trk12.6-20.0cm", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12006 smpl rpr scalp/neck/ax/genit/trunk 20.1-30.0cm techfee", "code_information": [ { "code": "12006", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/a/gen/trk20.1-30.0cm", "code_information": [ { "code": "12006", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12007 simple repair scalp/neck/ax/genit/trunk >30.0cm techfee", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr s/n/ax/gen/trnk >30.0 cm", "code_information": [ { "code": "12007", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12011 simple repair f/e/e/n/l/m 2.5cm/<", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "1 through 10", "median_amount": 268.99, "10th_percentile": 268.99, "90th_percentile": 268.99, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr f/e/e/n/l/m 2.5 cm/<", "code_information": [ { "code": "12011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "1 through 10", "median_amount": 268.99, "10th_percentile": 268.99, "90th_percentile": 268.99, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12013 simple repair f/e/e/n/l/m 2.6cm-5.0 cm techfee", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr f/e/e/n/l/m 2.6-5.0 cm", "code_information": [ { "code": "12013", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12014 simple repair f/e/e/n/l/m 5.1cm-7.5 cm techfee", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr f/e/e/n/l/m 5.1-7.5 cm", "code_information": [ { "code": "12014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12015 simple repair f/e/e/n/l/m 7.6cm-12.5 cm techfee", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr f/e/e/n/l/m 7.6-12.5 cm", "code_information": [ { "code": "12015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12016 simple repair f/e/e/n/l/m 12.6cm-20.0 cm techfee", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr fe/e/en/l/m 12.6-20.0 cm", "code_information": [ { "code": "12016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12017 simple repair f/e/e/n/l/m 20.1cm-30.0 cm techfee", "code_information": [ { "code": "12017", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr fe/e/en/l/m 20.1-30.0 cm", "code_information": [ { "code": "12017", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12018 simple repair f/e/e/n/l/m >30.0 cm techfee", "code_information": [ { "code": "12018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr f/e/e/n/l/m >30.0 cm", "code_information": [ { "code": "12018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12020 tx superficial wound dehiscence simple closure techfee", "code_information": [ { "code": "12020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closure of split wound", "code_information": [ { "code": "12020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12021 tx superficial wound dehiscence w/packing techfee", "code_information": [ { "code": "12021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closure of split wound", "code_information": [ { "code": "12021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12031 repair intermediate s/a/t/e 2.5 cm/< techfee", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/a/t/ext 2.5 cm/<", "code_information": [ { "code": "12031", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12032 repair intermediate s/a/t/e 2.6-7.5 cm techfee", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/a/t/ext 2.6-7.5", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12034 repair intermediate s/a/t/e 7.6-12.5 cm techfee", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/tr/ext 7.6-12.5", "code_information": [ { "code": "12034", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12035 repair intermediate s/a/t/e 12.6-20.0cm techfee", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/a/t/ext 12.6-20", "code_information": [ { "code": "12035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12036 repair intermediate s/a/t/e 20.1-30.0 cm techfee", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/a/t/ext 20.1-30", "code_information": [ { "code": "12036", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12037 repair intermediate s/a/t/e >30.0 cm techfee", "code_information": [ { "code": "12037", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5586.00, "discounted_cash": 5586.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr s/tr/ext >30.0 cm", "code_information": [ { "code": "12037", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5586.00, "discounted_cash": 5586.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12041 repair intermediate n/h/f/xtrnl gent 2.5cm/< techfee", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit 2.5cm/<", "code_information": [ { "code": "12041", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12042 repair intermediate n/h/f/xtrnl gent 2.6-7.5 cm techfee", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1064.00, "discounted_cash": 1064.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit2.6-7.5", "code_information": [ { "code": "12042", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1064.00, "discounted_cash": 1064.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12044 repair intermediate n/h/f/xtrnl gent 7.6-12.5cm techfee", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit7.6-12.5", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12045 repair intermediate n/h/f/xtrnl gent 12.6-20 cm techfee", "code_information": [ { "code": "12045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit12.6-20", "code_information": [ { "code": "12045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12046 rpr intermediate n/h/f/xtrnl gent 20.1-30.0 cm techfee", "code_information": [ { "code": "12046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit20.1-30", "code_information": [ { "code": "12046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12047 repair intermediate n/h/f/xtrnl gent >30.0 cm techfee", "code_information": [ { "code": "12047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5586.00, "discounted_cash": 5586.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr n-hf/genit >30.0cm", "code_information": [ { "code": "12047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5586.00, "discounted_cash": 5586.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12051 repair intermediate f/e/e/n/l&/muc 2.5 cm/< techfee", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 2.5 cm/<", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12052 repair intermediate f/e/e/n/l&/muc 2.6-5.0 cm techfee", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 2.6-5.0 cm", "code_information": [ { "code": "12052", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12053 repair intermediate f/e/e/n/l&/muc 5.1-7.5 cm techfee", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 5.1-7.5 cm", "code_information": [ { "code": "12053", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12054 repair intermediate f/e/e/n/l&/muc 7.6-12.5 cm techfee", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 7.6-12.5cm", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12055 repair intermediate f/e/e/n/l&/muc 12.6-20.0cm techfee", "code_information": [ { "code": "12055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 12.6-20 cm", "code_information": [ { "code": "12055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12056 repair intermediate f/e/e/n/l&/muc 20.1-30.0cm techfee", "code_information": [ { "code": "12056", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm 20.1-30.0", "code_information": [ { "code": "12056", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "12057 repair intermediate f/e/e/n/l&/muc >30.0 cm techfee", "code_information": [ { "code": "12057", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intmd rpr face/mm >30.0 cm", "code_information": [ { "code": "12057", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13100 repair complex trunk 1.1-2.5 cm techfee", "code_information": [ { "code": "13100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr trunk 1.1-2.5 cm", "code_information": [ { "code": "13100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13101 repair complex trunk 2.6-7.5 cm techfee", "code_information": [ { "code": "13101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr trunk 2.6-7.5 cm", "code_information": [ { "code": "13101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13102 repair complex trunk each additional 5 cm/< techfee", "code_information": [ { "code": "13102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 622.00, "discounted_cash": 622.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr trunk addl 5cm/<", "code_information": [ { "code": "13102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 622.00, "discounted_cash": 622.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13120 repair complex scalp/arm/leg 1.1-2.5 cm techfee", "code_information": [ { "code": "13120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr s/a/l 1.1-2.5 cm", "code_information": [ { "code": "13120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13121 repair complex scalp/arm/leg 2.6-7.5 cm techfee", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr s/a/l 2.6-7.5 cm", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13122 repair complex scalp/arm/leg ea addl 5 cm/< techfee", "code_information": [ { "code": "13122", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 622.00, "discounted_cash": 622.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr s/a/l addl 5 cm/>", "code_information": [ { "code": "13122", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 622.00, "discounted_cash": 622.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13131 repair complex f/c/c/m/n/ax/g/h/f 1.1-2.5 cm techfee", "code_information": [ { "code": "13131", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr f/c/c/m/n/ax/g/h/f", "code_information": [ { "code": "13131", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13132 repair complex f/c/c/m/n/ax/g/h/f 2.6-7.5 cm techfee", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr f/c/c/m/n/ax/g/h/f", "code_information": [ { "code": "13132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13133 repair complex f/c/c/m/n/ax/g/h/f ea addl 5 cm/< techfee", "code_information": [ { "code": "13133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 622.00, "discounted_cash": 622.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr f/c/c/m/n/ax/g/h/f", "code_information": [ { "code": "13133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 622.00, "discounted_cash": 622.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13151 repair complex eyelid/nose/ear/lip 1.1-2.5 cm techfee", "code_information": [ { "code": "13151", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr e/n/e/l 1.1-2.5 cm", "code_information": [ { "code": "13151", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13152 repair complex eyelid/nose/ear/lip 2.6-7.5 cm techfee", "code_information": [ { "code": "13152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr e/n/e/l 2.6-7.5 cm", "code_information": [ { "code": "13152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1711.00, "discounted_cash": 1711.00, "minimum": 629.15, "maximum": 662.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 629.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 662.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13153 repair complx eyelid/nose/ear/lip ea addl 5 cm/ techfee", "code_information": [ { "code": "13153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 622.00, "discounted_cash": 622.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmplx rpr e/n/e/l addl 5cm/<", "code_information": [ { "code": "13153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 622.00, "discounted_cash": 622.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "13160 secondary closure of surgical wound dehiscence extensive/complicated techfee", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5586.00, "discounted_cash": 5586.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Late closure of wound", "code_information": [ { "code": "13160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5586.00, "discounted_cash": 5586.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tis trnfr s/a/l 10 sq cm/<", "code_information": [ { "code": "14020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6704.00, "discounted_cash": 6704.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tis trnfr f/c/c/m/n/a/g/h/f", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6696.39, "discounted_cash": 6696.39, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tis trnfr e/n/e/l 10 sq cm/<", "code_information": [ { "code": "14060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14305.80, "discounted_cash": 14305.80, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin sub graft trnk/arm/leg", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22082.67, "discounted_cash": 22082.67, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "15272 alpy skin subst leg additional25 sq cm charge", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 64.00, "discounted_cash": 64.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin sub graft t/a/l add-on", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 64.00, "discounted_cash": 64.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin sub graft face/nk/hf/g", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23385.25, "discounted_cash": 23385.25, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "15276 aply skin subst feet additional25 sq cm charge", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 94.00, "discounted_cash": 94.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Skin sub graft f/n/hf/g addl", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 94.00, "discounted_cash": 94.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc myoq/fscq flp h&n pedcl", "code_information": [ { "code": "15733", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10484.70, "discounted_cash": 10484.70, "minimum": 3762.74, "maximum": 3960.77, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3762.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3762.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3762.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muscle-skin graft arm", "code_information": [ { "code": "15736", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6435.00, "discounted_cash": 6435.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "15851 removal of sutures under anes other surgeon techfee", "code_information": [ { "code": "15851", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5586.00, "discounted_cash": 5586.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove sutures diff surgeon", "code_information": [ { "code": "15851", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5586.00, "discounted_cash": 5586.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove sacrum pressure sore", "code_information": [ { "code": "15933", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "minimum": 2941.61, "maximum": 3096.43, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove sacrum pressure sore", "code_information": [ { "code": "15935", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "minimum": 3762.74, "maximum": 3960.77, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3762.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3762.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3762.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3960.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove sacrum pressure sore", "code_information": [ { "code": "15937", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "minimum": 1880.08, "maximum": 1979.03, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "16000 initial tx 1st degree burn local tx techfee", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Initial treatment of burn(s)", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "16020 drs&/dbrdmt prtl-thkns burns 1st/sbsq small techfee", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dress/debrid p-thick burn s", "code_information": [ { "code": "16020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "16025 drs&/dbrdmt prtl-thkns burns 1st/sbsq medium techfee", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dress/debrid p-thick burn m", "code_information": [ { "code": "16025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "16030 drs&/dbrdmt prtl-thkns burns 1st/sbsq large techfee", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dress/debrid p-thick burn l", "code_information": [ { "code": "16030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "16035 escharotomy 1st inc techfee", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of burn scab initi", "code_information": [ { "code": "16035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1101.00, "discounted_cash": 1101.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20103 exploration penetrating wound spx extremity techfee", "code_information": [ { "code": "20103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Explore wound extremity", "code_information": [ { "code": "20103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20245 biopsy bone open-lchn", "code_information": [ { "code": "20245", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8222.00, "discounted_cash": 8222.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone biopsy open deep", "code_information": [ { "code": "20245", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8222.00, "discounted_cash": 8222.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20520 removal foreign body muscle/tendon sheath simple", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4614.00, "discounted_cash": 4614.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foreign body", "code_information": [ { "code": "20520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4614.00, "discounted_cash": 4614.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20525 rmvl foreign body muscle/tendon sheath deep/comp techfee", "code_information": [ { "code": "20525", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7983.00, "discounted_cash": 7983.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foreign body", "code_information": [ { "code": "20525", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7983.00, "discounted_cash": 7983.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20526 bilat injection therapeutic carpal tunnel", "code_information": [ { "code": "20526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1282.00, "discounted_cash": 1282.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther injection carp tunnel", "code_information": [ { "code": "20526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1282.00, "discounted_cash": 1282.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20550 bilat injection(s); single tendon sheath or ligament aponeurosis", "code_information": [ { "code": "20550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1282.00, "discounted_cash": 1282.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj tendon sheath/ligament", "code_information": [ { "code": "20550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1282.00, "discounted_cash": 1282.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20551 inject single tendon ori techfee", "code_information": [ { "code": "20551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.00, "discounted_cash": 901.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj tendon origin/insertion", "code_information": [ { "code": "20551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 901.00, "discounted_cash": 901.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20552 injection single/mlt trigger point 1/2 muscles techfee", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 718.00, "discounted_cash": 718.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj trigger point 1/2 muscl", "code_information": [ { "code": "20552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 718.00, "discounted_cash": 718.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20553 injection single/mlt trigger point 3/> muscles techfee", "code_information": [ { "code": "20553", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 861.00, "discounted_cash": 861.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject trigger points 3/>", "code_information": [ { "code": "20553", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 861.00, "discounted_cash": 861.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20560 needle insertion without injection techfee", "code_information": [ { "code": "20560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79.00, "discounted_cash": 79.00, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ndl insj w/o njx 1 or 2 musc", "code_information": [ { "code": "20560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79.00, "discounted_cash": 79.00, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20600 joints finger/toe ing", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 546.00, "discounted_cash": 546.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "1 through 10", "median_amount": 117.03, "10th_percentile": 62.94, "90th_percentile": 171.11, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 546.00, "discounted_cash": 546.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "1 through 10", "median_amount": 117.03, "10th_percentile": 62.94, "90th_percentile": 171.11, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6789.93, "discounted_cash": 6789.93, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1685.00, "discounted_cash": 1685.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1321.00, "discounted_cash": 1321.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6789.93, "discounted_cash": 6789.93, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2594.95, "discounted_cash": 2594.95, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "1 through 10", "median_amount": 65.70, "10th_percentile": 19.93, "90th_percentile": 94.37, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2594.95, "discounted_cash": 2594.95, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "1 through 10", "median_amount": 43.34, "10th_percentile": 43.34, "90th_percentile": 463.82, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "22", "median_amount": 59.80, "10th_percentile": 59.80, "90th_percentile": 94.37, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "16", "median_amount": 63.95, "10th_percentile": 47.53, "90th_percentile": 95.06, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1497.07, "discounted_cash": 1497.07, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "12", "median_amount": 67.13, "10th_percentile": 39.88, "90th_percentile": 98.57, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "18", "median_amount": 63.37, "10th_percentile": 31.69, "90th_percentile": 113.42, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/o us", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1512.48, "discounted_cash": 1512.48, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "1 through 10", "median_amount": 87.76, "10th_percentile": 43.34, "90th_percentile": 132.18, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "18", "median_amount": 98.57, "10th_percentile": 15.82, "90th_percentile": 285.11, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20611 bilat arthrocentesis aspiration and/or injection major joint or bursa", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1951.00, "discounted_cash": 1951.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain/inj joint/bursa w/us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1951.00, "discounted_cash": 1951.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "20670 removal of implant; superficial (separate procedure) techfee", "code_information": [ { "code": "20670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4645.00, "discounted_cash": 4645.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of support implant", "code_information": [ { "code": "20670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4645.00, "discounted_cash": 4645.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of bone for graft", "code_information": [ { "code": "20900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "minimum": 7342.31, "maximum": 7728.74, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of bone for graft", "code_information": [ { "code": "20902", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "minimum": 7342.31, "maximum": 7728.74, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Other bone graft microvasc", "code_information": [ { "code": "20962", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone/skin graft microvasc", "code_information": [ { "code": "20969", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "21315 closed tx nasal fracture w/o stabilization", "code_information": [ { "code": "21315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2295.00, "discounted_cash": 2295.00, "minimum": 1522.46, "maximum": 1602.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closed tx nose fx w/o stablj", "code_information": [ { "code": "21315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2295.00, "discounted_cash": 2295.00, "minimum": 1522.46, "maximum": 1602.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "21320 closed treatment nasal fracture w/stabilization techfee", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9017.00, "discounted_cash": 9017.00, "minimum": 3333.22, "maximum": 3508.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Closed tx nose fx w/ stablj", "code_information": [ { "code": "21320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9017.00, "discounted_cash": 9017.00, "minimum": 3333.22, "maximum": 3508.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "21450 closed treatment of mandibular fracture; without manipulatio techfee", "code_information": [ { "code": "21450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1521.00, "discounted_cash": 1521.00, "minimum": 523.41, "maximum": 550.95, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat lower jaw fracture", "code_information": [ { "code": "21450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1521.00, "discounted_cash": 1521.00, "minimum": 523.41, "maximum": 550.95, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "21451 closed treatment of mandibular fracture; with manipulation techfee", "code_information": [ { "code": "21451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4645.00, "discounted_cash": 4645.00, "minimum": 1522.46, "maximum": 1602.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat lower jaw fracture", "code_information": [ { "code": "21451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4645.00, "discounted_cash": 4645.00, "minimum": 1522.46, "maximum": 1602.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "21820 ed clsd trt sternum fx charge", "code_information": [ { "code": "21820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 735.00, "discounted_cash": 735.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat sternum fracture", "code_information": [ { "code": "21820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 735.00, "discounted_cash": 735.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc abd les sc 3 cm/>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7532.50, "discounted_cash": 7532.50, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc shoulder tum deep 5 cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21398.83, "discounted_cash": 21398.83, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc shoulder tum deep 5 cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8685.56, "discounted_cash": 8685.56, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc shoulder tum deep 5 cm/>", "code_information": [ { "code": "23073", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21398.83, "discounted_cash": 21398.83, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reconstruct shoulder joint", "code_information": [ { "code": "23470", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57164.83, "discounted_cash": 57164.83, "minimum": 13224.48, "maximum": 13920.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reconstruct shoulder joint", "code_information": [ { "code": "23470", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57164.83, "discounted_cash": 57164.83, "minimum": 13224.48, "maximum": 13920.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reconstruct shoulder joint", "code_information": [ { "code": "23472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 65123.81, "discounted_cash": 65123.81, "minimum": 18901.25, "maximum": 19896.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 18901.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 18901.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 18901.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reconstruct shoulder joint", "code_information": [ { "code": "23472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 65123.81, "discounted_cash": 65123.81, "minimum": 18901.25, "maximum": 19896.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 18901.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 18901.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 18901.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 19896.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23500 closed tx clavicular fracture w/o manipulation", "code_information": [ { "code": "23500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat clavicle fracture", "code_information": [ { "code": "23500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23505 treat clavicle fracture techfee", "code_information": [ { "code": "23505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat clavicle fracture", "code_information": [ { "code": "23505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23515 open treatment clavicular fracture /internal fixation when performed", "code_information": [ { "code": "23515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21695.00, "discounted_cash": 21695.00, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat clavicle fracture", "code_information": [ { "code": "23515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21695.00, "discounted_cash": 21695.00, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23520 sternoclavicular disl w/o techfee", "code_information": [ { "code": "23520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat clavicle dislocation", "code_information": [ { "code": "23520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23540 treat clavicle dislocation techfee", "code_information": [ { "code": "23540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat clavicle dislocation", "code_information": [ { "code": "23540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23545 ac joint dislocation procedure performed.", "code_information": [ { "code": "23545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat clavicle dislocation", "code_information": [ { "code": "23545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23570 closed treatment of scapular fracture; without manipulation techfee", "code_information": [ { "code": "23570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat shoulder blade fx", "code_information": [ { "code": "23570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23575 closed tx scapular fx w/manj w/wo skeletal traction", "code_information": [ { "code": "23575", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat shoulder blade fx", "code_information": [ { "code": "23575", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23600 closed tx prox humerus fx w/o manipulation", "code_information": [ { "code": "23600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "23600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23605 cltx prox humrl fx w/manj w/wo skeletal tracj techfee", "code_information": [ { "code": "23605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "23605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23620 cltx greater humeral tuberosity fx w/o manj techfee", "code_information": [ { "code": "23620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "23620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23625 cltx grter humeral tuberosity fx w/manipulation tech fee", "code_information": [ { "code": "23625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "23625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23650 closed tx shoulder dislc w/manipulation w/o anes", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat shoulder dislocation", "code_information": [ { "code": "23650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23655 clsd tx shoulder dislc w/manipulation req anes", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat shoulder dislocation", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23665 cltx shoulder dislc w/fx humeral tubrst w/manj techfee", "code_information": [ { "code": "23665", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat dislocation/fracture", "code_information": [ { "code": "23665", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23700 manipulation under anes shoulder jt inc app of fixation apparatus (dislocation excluded)", "code_information": [ { "code": "23700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4874.00, "discounted_cash": 4874.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fixation of shoulder", "code_information": [ { "code": "23700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4874.00, "discounted_cash": 4874.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "23931 incision and drainage upper arm or elbow area; bursa techfee", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4726.00, "discounted_cash": 4726.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of arm bursa", "code_information": [ { "code": "23931", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4726.00, "discounted_cash": 4726.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24076 exc tumor soft tissue upper arm/elbow area subfascial less than 5 cm", "code_information": [ { "code": "24076", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8618.00, "discounted_cash": 8618.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ex arm/elbow tum deep < 5 cm", "code_information": [ { "code": "24076", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8618.00, "discounted_cash": 8618.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24200 fb rem upper arm/elbow-sq techfee", "code_information": [ { "code": "24200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4614.00, "discounted_cash": 4614.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of arm foreign body", "code_information": [ { "code": "24200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4614.00, "discounted_cash": 4614.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24500 clsd tx humeral shaft fracture w/o man", "code_information": [ { "code": "24500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "24500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24505 cltx humeral shft fx w/manj w/wo skeletal tracj techfee", "code_information": [ { "code": "24505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "24505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24530 clsd tx humeral frac w/w/out intercon ext w/out manip", "code_information": [ { "code": "24530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "24530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24535 cltx sprcndylr/transcndylr humeral fx w/manj", "code_information": [ { "code": "24535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "24535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24560 closed treat hum epicon frac medial or lat; w/out manip techfee", "code_information": [ { "code": "24560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "24560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24565 cltx humeral epicondylar fx medial/lat w/manj techfee", "code_information": [ { "code": "24565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "24565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24576 cltx humeral condylar fx medial/lat w/o manj techfee", "code_information": [ { "code": "24576", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "24576", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24577 cltx humeral condylar fx medial/lateral w/manj techfee", "code_information": [ { "code": "24577", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat humerus fracture", "code_information": [ { "code": "24577", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24600 closed tx elbow dislocation w/o anes", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat elbow dislocation", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24605 treatment closed elbow dislocation req anes techfee", "code_information": [ { "code": "24605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat elbow dislocation", "code_information": [ { "code": "24605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24620 closed tx monteggia fx dislocation elbow w/manj techfee", "code_information": [ { "code": "24620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat elbow fracture", "code_information": [ { "code": "24620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24640 cltx rdl head sublxtj chld nursemaid elbw w/manj", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat elbow dislocation", "code_information": [ { "code": "24640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24650 closed tx radial head/neck fx w/o manipulation", "code_information": [ { "code": "24650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat radius fracture", "code_information": [ { "code": "24650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24655 closed tx radial head/neck fx w/manipulation", "code_information": [ { "code": "24655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat radius fracture", "code_information": [ { "code": "24655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24670 closed tx ulnar fx prox", "code_information": [ { "code": "24670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat ulnar fracture", "code_information": [ { "code": "24670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "24675 closed tx ulnar fracture proximal end w/manj techfee", "code_information": [ { "code": "24675", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat ulnar fracture", "code_information": [ { "code": "24675", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of tendon sheath", "code_information": [ { "code": "25000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13081.00, "discounted_cash": 13081.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of tendon sheath", "code_information": [ { "code": "25000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13081.00, "discounted_cash": 13081.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25111 excision of ganglion wrist (dorsal or volar); primary", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4566.00, "discounted_cash": 4566.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove wrist tendon lesion", "code_information": [ { "code": "25111", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4566.00, "discounted_cash": 4566.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25112 excision ganglion wrist recurrent-lchn", "code_information": [ { "code": "25112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4566.00, "discounted_cash": 4566.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reremove wrist tendon lesion", "code_information": [ { "code": "25112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4566.00, "discounted_cash": 4566.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25500 closed tx fx radial shaft w/o man", "code_information": [ { "code": "25500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture of radius", "code_information": [ { "code": "25500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25505 closed tx fx radial shaft w/manipulation", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture of radius", "code_information": [ { "code": "25505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25520 clx rdl shft fx/clx dislc techfee", "code_information": [ { "code": "25520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture of radius", "code_information": [ { "code": "25520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25530 closed tx ulnar shaft fracture w/o manipulation techfee", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture of ulna", "code_information": [ { "code": "25530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25535 closed tx ulnar shaft fracture; with manipulation", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture of ulna", "code_information": [ { "code": "25535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25560 closed tx radial&ulnar shaft fractures w/o man techfee", "code_information": [ { "code": "25560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture radius & ulna", "code_information": [ { "code": "25560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25565 closed tx radial & ulnar shaft fract w/manj", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture radius & ulna", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25600 cltx dstl radial fx/epiphysl sep w/o manj", "code_information": [ { "code": "25600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture radius/ulna", "code_information": [ { "code": "25600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25605 cltx dstl rdl fx/epiphysl sep w/manj when perf", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fracture radius/ulna", "code_information": [ { "code": "25605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25606 perq skel fixj distal radial fx/epiphysl sep techfee", "code_information": [ { "code": "25606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat fx distal radial", "code_information": [ { "code": "25606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25622 clsd tx carpal scaphoid (navicular) fracture w/o man", "code_information": [ { "code": "25622", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat wrist bone fracture", "code_information": [ { "code": "25622", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25624 closed tx carpal scaphoid fracture w/manj techfee", "code_information": [ { "code": "25624", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat wrist bone fracture", "code_information": [ { "code": "25624", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25630 clsd tx carpal bone fxw/o man ea bone", "code_information": [ { "code": "25630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat wrist bone fracture", "code_information": [ { "code": "25630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25635 cltx carpal bone fx w/manj each bone techfee", "code_information": [ { "code": "25635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat wrist bone fracture", "code_information": [ { "code": "25635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25650 closed treatment ulnar styloid fracture techfee", "code_information": [ { "code": "25650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat wrist bone fracture", "code_information": [ { "code": "25650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25660 closed treat radio/intercarp disloc 1-more bones w/manip techfee", "code_information": [ { "code": "25660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat wrist dislocation", "code_information": [ { "code": "25660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25675 closed tx distal radioulnar dislocation w/manj techfee", "code_information": [ { "code": "25675", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat wrist dislocation", "code_information": [ { "code": "25675", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25680 closed treatmenttrans-scaphoperilunar typefracture disloc w/ manip techfee", "code_information": [ { "code": "25680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat wrist fracture", "code_information": [ { "code": "25680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "25690 closed tx lunate dislocation w/manipulation techfee", "code_information": [ { "code": "25690", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat wrist dislocation", "code_information": [ { "code": "25690", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26010 drainage finger abscess simple", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of finger abscess", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26011 drainage finger abscess complicated techfee", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4843.00, "discounted_cash": 4843.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of finger abscess", "code_information": [ { "code": "26011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4843.00, "discounted_cash": 4843.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incise finger tendon sheath", "code_information": [ { "code": "26055", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8832.25, "discounted_cash": 8832.25, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc hand les sc < 1.5 cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4621.00, "discounted_cash": 4621.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26418 repair extensor tendon finger w/o graft each techfee", "code_information": [ { "code": "26418", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair finger tendon", "code_information": [ { "code": "26418", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Release hand/finger tendon", "code_information": [ { "code": "26445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13612.06, "discounted_cash": 13612.06, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26480 transfer or transplant/tendon carpometacarpal area or dorsum of hand wo free graft ea tendo", "code_information": [ { "code": "26480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9816.00, "discounted_cash": 9816.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Transplant hand tendon", "code_information": [ { "code": "26480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9816.00, "discounted_cash": 9816.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26600 cltx metacarpal fx w/o manipulation each bone", "code_information": [ { "code": "26600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26605 cltx metacarpal fx w/manipulation each bone", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26607 treat metacarpal fracture ed tech fee", "code_information": [ { "code": "26607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat metacarpal fracture", "code_information": [ { "code": "26607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26641 cltx carpo/metacarpal dislocation thumb w/manj techfee", "code_information": [ { "code": "26641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat thumb dislocation", "code_information": [ { "code": "26641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26645 cltx carpo/metacarpal fx dislc thumb w/manj techfee", "code_information": [ { "code": "26645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat thumb fracture", "code_information": [ { "code": "26645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26670 cltx carpo/metacarpl dislc thmb manj ea w/o anes techfee", "code_information": [ { "code": "26670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat hand dislocation", "code_information": [ { "code": "26670", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26675 cltx carpo/mtcrpl dislc thumb man ea jt w/anes techfee", "code_information": [ { "code": "26675", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat hand dislocation", "code_information": [ { "code": "26675", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26700 cltx metacarpophalangeal dislc w/man w/o anes", "code_information": [ { "code": "26700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat knuckle dislocation", "code_information": [ { "code": "26700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26705 cl tx knucle disloc/anest techfee", "code_information": [ { "code": "26705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat knuckle dislocation", "code_information": [ { "code": "26705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26720 cltx phlngl fx prox/middle px/f/t w/o man ea", "code_information": [ { "code": "26720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fracture each", "code_information": [ { "code": "26720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26725 cltx phlngl fx prox/middle px/f/t w/man ea", "code_information": [ { "code": "26725", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fracture each", "code_information": [ { "code": "26725", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26740 cltx artclr fx invg mtcrphlngl/iphal jt w/o manj techfee", "code_information": [ { "code": "26740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fracture each", "code_information": [ { "code": "26740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26742 cltx artclr fx invg mtcarphlngl/iphal jt w/man", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fracture each", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26750 cltx dstl phlngl fx fngr/thmb w/o man ea", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fracture each", "code_information": [ { "code": "26750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26755 cltx dstl phlngl fx fngr/thmb w/man ea", "code_information": [ { "code": "26755", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fracture each", "code_information": [ { "code": "26755", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26765 open tx distal phalangeal fracture each", "code_information": [ { "code": "26765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger fracture each", "code_information": [ { "code": "26765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26770 cl tx interphalangeal jt dislc w/man w/o anes", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger dislocation", "code_information": [ { "code": "26770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26775 cltx iphal jt dislc w/manj req anes techfee", "code_information": [ { "code": "26775", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat finger dislocation", "code_information": [ { "code": "26775", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26951 amp f/th 1/2 jt/phalanx w/neurect w/dir clsr", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amputation of finger/thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "26952 amputation finger/thumb prim/sec w/local adv flaps", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9474.00, "discounted_cash": 9474.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amputation of finger/thumb", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9474.00, "discounted_cash": 9474.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject sacroiliac joint", "code_information": [ { "code": "27096", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4352.60, "discounted_cash": 4352.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject sacroiliac joint", "code_information": [ { "code": "27096", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4352.60, "discounted_cash": 4352.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject sacroiliac joint", "code_information": [ { "code": "27096", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2976.10, "discounted_cash": 2976.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject sacroiliac joint", "code_information": [ { "code": "27096", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3012.78, "discounted_cash": 3012.78, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total hip arthroplasty", "code_information": [ { "code": "27130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 68345.23, "discounted_cash": 68345.23, "minimum": 13224.48, "maximum": 13920.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total hip arthroplasty", "code_information": [ { "code": "27130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 68345.23, "discounted_cash": 68345.23, "minimum": 13224.48, "maximum": 13920.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total hip arthroplasty", "code_information": [ { "code": "27130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60618.63, "discounted_cash": 60618.63, "minimum": 13224.48, "maximum": 13920.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 13920.51, "count": "12", "median_amount": 6309.37, "10th_percentile": 1050.29, "90th_percentile": 11698.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27197 closed tx post pelvic rng fx w/o manipul techfee", "code_information": [ { "code": "27197", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clsd tx pelvic ring fx", "code_information": [ { "code": "27197", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27198 closted tx post pelvis rng fx w/ manipul techfee", "code_information": [ { "code": "27198", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clsd tx pelvic ring fx", "code_information": [ { "code": "27198", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27200 closed treatment of coccygeal fracture techfee", "code_information": [ { "code": "27200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat tail bone fracture", "code_information": [ { "code": "27200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27230 cl tx femoral neck fx techfee", "code_information": [ { "code": "27230", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat thigh fracture", "code_information": [ { "code": "27230", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27238 clx intr/peri/sub fem fx techfee", "code_information": [ { "code": "27238", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat thigh fracture", "code_information": [ { "code": "27238", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27246 clx > trchntric fx wo techfee", "code_information": [ { "code": "27246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat thigh fracture", "code_information": [ { "code": "27246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27250 cltx hip dislocation traumatic w/o anesthesia", "code_information": [ { "code": "27250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat hip dislocation", "code_information": [ { "code": "27250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27252 cltx hip dislocation traumatic req anesthesia techfee", "code_information": [ { "code": "27252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat hip dislocation", "code_information": [ { "code": "27252", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27256 treatment of spontaneous hip dislocation techfee", "code_information": [ { "code": "27256", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat hip dislocation", "code_information": [ { "code": "27256", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27257 tx spon hip dsl abdt spln techfee", "code_information": [ { "code": "27257", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat hip dislocation", "code_information": [ { "code": "27257", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27265 cltx post hip arthrp dislc w/o anes techfee", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat hip dislocation", "code_information": [ { "code": "27265", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27266 cltx post hip arthrplasty dislc req anes", "code_information": [ { "code": "27266", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat hip dislocation", "code_information": [ { "code": "27266", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27301 i&d deep absc bursa/hematoma thigh/knee region techfee", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7983.00, "discounted_cash": 7983.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain thigh/knee lesion", "code_information": [ { "code": "27301", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7983.00, "discounted_cash": 7983.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27310 arthrotomy knee w/exploration drainage or rem foreign body", "code_information": [ { "code": "27310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9816.00, "discounted_cash": 9816.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exploration of knee joint", "code_information": [ { "code": "27310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9816.00, "discounted_cash": 9816.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc thigh/knee les sc 3 cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7747.46, "discounted_cash": 7747.46, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Exc thigh/knee les sc 3 cm/>", "code_information": [ { "code": "27337", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7747.46, "discounted_cash": 7747.46, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27372 removal of foreign body deep thigh region or knee area techfee", "code_information": [ { "code": "27372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7983.00, "discounted_cash": 7983.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foreign body", "code_information": [ { "code": "27372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7983.00, "discounted_cash": 7983.00, "minimum": 2941.61, "maximum": 3096.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2941.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3096.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27380 suture of infrapatellar tendon; prim", "code_information": [ { "code": "27380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21053.00, "discounted_cash": 21053.00, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of kneecap tendon", "code_information": [ { "code": "27380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21053.00, "discounted_cash": 21053.00, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27405 repair prim torn ligament and/or capsule knee collateral", "code_information": [ { "code": "27405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21053.00, "discounted_cash": 21053.00, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of knee ligament", "code_information": [ { "code": "27405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21053.00, "discounted_cash": 21053.00, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27407 repair prim torn ligament knee cruciate", "code_information": [ { "code": "27407", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21053.00, "discounted_cash": 21053.00, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of knee ligament", "code_information": [ { "code": "27407", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21053.00, "discounted_cash": 21053.00, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "2749 repair prim torn ligament collateral and cruciate ligaments", "code_information": [ { "code": "27409", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21053.00, "discounted_cash": 21053.00, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair of knee ligaments", "code_information": [ { "code": "27409", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21053.00, "discounted_cash": 21053.00, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total knee arthroplasty", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48368.57, "discounted_cash": 48368.57, "minimum": 13224.48, "maximum": 13920.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total knee arthroplasty", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49536.44, "discounted_cash": 49536.44, "minimum": 13224.48, "maximum": 13920.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 13920.51, "count": "13", "median_amount": 11439.10, "10th_percentile": 1142.02, "90th_percentile": 12514.04, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "1 through 10", "median_amount": 12791.55, "10th_percentile": 12791.55, "90th_percentile": 12791.55, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Total knee arthroplasty", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48353.44, "discounted_cash": 48353.44, "minimum": 13224.48, "maximum": 13920.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13224.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 13920.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27486 revision of total knee arthroplasty with or without allograft; 1 component profee", "code_information": [ { "code": "27486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4305.00, "discounted_cash": 4305.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise/replace knee joint", "code_information": [ { "code": "27486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4305.00, "discounted_cash": 4305.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27500 closed treat femoral shaft fracture without manipulation techfee", "code_information": [ { "code": "27500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27501 closed tx supracondylar fracture techfee", "code_information": [ { "code": "27501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27502 cltx fem shft fx w/manj w/wo skin/skeletal tracj techfee", "code_information": [ { "code": "27502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27503 closed treat of supracon/transcon fracture w/manip techfee", "code_information": [ { "code": "27503", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27503", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27508 cltx fem fx dstl end medial/lat condyle w/o manj techfee", "code_information": [ { "code": "27508", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27508", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27510 cltx fem fx dstl end medial/lat condyle w/manj techfee", "code_information": [ { "code": "27510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of thigh fracture", "code_information": [ { "code": "27510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27516 clx dstl tem epip sep wo techfee", "code_information": [ { "code": "27516", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat thigh fx growth plate", "code_information": [ { "code": "27516", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27517 clx dstl fem epip sep w m techfee", "code_information": [ { "code": "27517", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat thigh fx growth plate", "code_information": [ { "code": "27517", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27520 clsd tx patellar fx w/o manipulation", "code_information": [ { "code": "27520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat kneecap fracture", "code_information": [ { "code": "27520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27530 cltx tibial fx proximal w/o manipulation techfee", "code_information": [ { "code": "27530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat knee fracture", "code_information": [ { "code": "27530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27532 cltx tibial fx proximal w/wo manj w/skel tracj techfee", "code_information": [ { "code": "27532", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat knee fracture", "code_information": [ { "code": "27532", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27538 clx itrcondy spi/tub knee techfee", "code_information": [ { "code": "27538", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat knee fracture(s)", "code_information": [ { "code": "27538", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27550 closed tx knee dislocation w/o anesthesia techfee", "code_information": [ { "code": "27550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat knee dislocation", "code_information": [ { "code": "27550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27552 cl tx knee disloc + anes techfee", "code_information": [ { "code": "27552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat knee dislocation", "code_information": [ { "code": "27552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27560 closed tx patellar dislocation w/o anesthesia techfee", "code_information": [ { "code": "27560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat kneecap dislocation", "code_information": [ { "code": "27560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27562 closed tx patellar dislocation w/anesthesia", "code_information": [ { "code": "27562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat kneecap dislocation", "code_information": [ { "code": "27562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fixation of knee joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4856.01, "discounted_cash": 4856.01, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fixation of knee joint", "code_information": [ { "code": "27570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4856.01, "discounted_cash": 4856.01, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27750 cltx tibial shaft fx w/o manipulation techfee", "code_information": [ { "code": "27750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of tibia fracture", "code_information": [ { "code": "27750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27752 cltx tibial shaft fx w/manj w/wo skel tracj techfee", "code_information": [ { "code": "27752", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of tibia fracture", "code_information": [ { "code": "27752", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27760 cltx medial malleolus fx w/o manipulation techfee", "code_information": [ { "code": "27760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cltx medial ankle fx", "code_information": [ { "code": "27760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27780 cltx prox fibula/shft fx w/o manj techfee", "code_information": [ { "code": "27780", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of fibula fracture", "code_information": [ { "code": "27780", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27781 cltx prox fibula/shft fx w/manj techfee", "code_information": [ { "code": "27781", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of fibula fracture", "code_information": [ { "code": "27781", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27786 cltx dstl fibular fx lat malls w/o manj techfee", "code_information": [ { "code": "27786", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27786", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27788 cltx dstl fibular fx lat malls w/manj techfee", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27788", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27808 closed treatment of bimalleolar ankle fracture", "code_information": [ { "code": "27808", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27808", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27810 closed tx bimalleolar ankle fracture w/manj techfee", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27816 cltx trimalleolar ankle fx w/o manipulation techfee", "code_information": [ { "code": "27816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27818 cltx trimalleolar ankle fx w/manipulation techfee", "code_information": [ { "code": "27818", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "27818", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27824 cltx fx w8 brg artclr prtn dstl tibia w/o manj techfee", "code_information": [ { "code": "27824", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat lower leg fracture", "code_information": [ { "code": "27824", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27825 cltx fx w8 brg artclr prtn dstl tib w/skel tracj techfee", "code_information": [ { "code": "27825", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat lower leg fracture", "code_information": [ { "code": "27825", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27830 cl tx prx tib/fib disloc techfee", "code_information": [ { "code": "27830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat lower leg dislocation", "code_information": [ { "code": "27830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27831 cl tx prx tib/fib disloc techfee", "code_information": [ { "code": "27831", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat lower leg dislocation", "code_information": [ { "code": "27831", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27840 closed tx ankle dislocation w/o anesthesia", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat ankle dislocation", "code_information": [ { "code": "27840", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27842 cltx ankle dislc req anes w/wo prq skel fixj techfee", "code_information": [ { "code": "27842", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat ankle dislocation", "code_information": [ { "code": "27842", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28190 removal foreign body foot subcutaneous techfee", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2240.00, "discounted_cash": 2240.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foot foreign body", "code_information": [ { "code": "28190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2240.00, "discounted_cash": 2240.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28192 removal foreign body foot deep techfee", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4726.00, "discounted_cash": 4726.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foot foreign body", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4726.00, "discounted_cash": 4726.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28193 fb removal foot comp techfee", "code_information": [ { "code": "28193", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4726.00, "discounted_cash": 4726.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of foot foreign body", "code_information": [ { "code": "28193", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4726.00, "discounted_cash": 4726.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28400 calcaneal fx techfee", "code_information": [ { "code": "28400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of heel fracture", "code_information": [ { "code": "28400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28405 closed tx calcaneal fracture w/manipulation techfee", "code_information": [ { "code": "28405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of heel fracture", "code_information": [ { "code": "28405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28430 clsd tx talus fx w/o man techfee", "code_information": [ { "code": "28430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "28430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28435 closed tx talus fracture w/manipulation techfee", "code_information": [ { "code": "28435", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of ankle fracture", "code_information": [ { "code": "28435", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28450 treatment of tarsal bone fracture w/o manipulation each techfee", "code_information": [ { "code": "28450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat midfoot fracture each", "code_information": [ { "code": "28450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28455 tx tarsal bone fx xcp talus&calcn w/manj techfee", "code_information": [ { "code": "28455", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat midfoot fracture each", "code_information": [ { "code": "28455", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28470 closed tx metatarsal fracture w/o manipulation", "code_information": [ { "code": "28470", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat metatarsal fracture", "code_information": [ { "code": "28470", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28475 closed tx metatarsal fracture w/ manipulation each", "code_information": [ { "code": "28475", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat metatarsal fracture", "code_information": [ { "code": "28475", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28490 cltx fx grt toe phlx/phlg w/o manj techfee", "code_information": [ { "code": "28490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat big toe fracture", "code_information": [ { "code": "28490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28495 cltx fx grt toe phlx/phlg w/manj techfee", "code_information": [ { "code": "28495", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat big toe fracture", "code_information": [ { "code": "28495", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28510 cltx fx phlx/phlg oth/thn grt toe w/o manj techfee", "code_information": [ { "code": "28510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of toe fracture", "code_information": [ { "code": "28510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28515 cltx fx phlx/phlg oth/thn grt toe w/man", "code_information": [ { "code": "28515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of toe fracture", "code_information": [ { "code": "28515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28530 closed treatment sesamoid fracture techfee", "code_information": [ { "code": "28530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat sesamoid bone fracture", "code_information": [ { "code": "28530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28540 reduce disloc tarsal techfee", "code_information": [ { "code": "28540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat foot dislocation", "code_information": [ { "code": "28540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28545 cltx tarsal dislc w anes techfee", "code_information": [ { "code": "28545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat foot dislocation", "code_information": [ { "code": "28545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "27570 manipulation of knee joint under general anesthesia techfee", "code_information": [ { "code": "28570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat foot dislocation", "code_information": [ { "code": "28570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28575 cltx talotarsal jt dis w techfee", "code_information": [ { "code": "28575", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat foot dislocation", "code_information": [ { "code": "28575", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9422.00, "discounted_cash": 9422.00, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28600 red dl tarsometatar techfee", "code_information": [ { "code": "28600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat foot dislocation", "code_information": [ { "code": "28600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28605 cltx tars jt dis w anes techfee", "code_information": [ { "code": "28605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat foot dislocation", "code_information": [ { "code": "28605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28630 cltx metatarsophlngl jt dislc w/o anes", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat toe dislocation", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28635 cltx metatarsophlngl jt dislc req anes techfee", "code_information": [ { "code": "28635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat toe dislocation", "code_information": [ { "code": "28635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4666.00, "discounted_cash": 4666.00, "minimum": 1644.90, "maximum": 1731.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1644.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1731.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28660 cltx interphalangeal joint dislocation w/o anes techfee", "code_information": [ { "code": "28660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat toe dislocation", "code_information": [ { "code": "28660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 743.00, "discounted_cash": 743.00, "minimum": 246.55, "maximum": 259.52, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 246.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 259.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "28665 closed treatment of interphalangeal joint dislocation; requiring anesthesia techfee", "code_information": [ { "code": "28665", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treat toe dislocation", "code_information": [ { "code": "28665", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29065 application cast shoulder hand long arm techfee", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of long arm cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29075 application cast elbow finger short arm techfee", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of forearm cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29085 application cast hand/lower forearm", "code_information": [ { "code": "29085", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply hand/wrist cast", "code_information": [ { "code": "29085", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29105 application long arm splint shoulder hand techfee", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply long arm splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29125 application short arm splint forearm-hand static techfee", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply forearm splint", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29126 application short arm splint dynamic techfee", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply forearm splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29130 application finger splint static techfee", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of finger splint", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29131 application finger splint dynamic techfee", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of finger splint", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29200 strapping; thorax techfee", "code_information": [ { "code": "29200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of chest", "code_information": [ { "code": "29200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29240 strapping shoulder techfee", "code_information": [ { "code": "29240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of shoulder", "code_information": [ { "code": "29240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29260 strapping elbow/wrist techfee", "code_information": [ { "code": "29260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 115.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of elbow or wrist", "code_information": [ { "code": "29260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 115.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29280 strapping hand/finger techfee", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 115.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of hand or finger", "code_information": [ { "code": "29280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 115.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29345 application long leg cast thigh-toe techfee", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of long leg cast", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29355 application of long leg cast (thigh to toes); walker or ambulatory type techfee", "code_information": [ { "code": "29355", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application of long leg cast", "code_information": [ { "code": "29355", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29405 application short leg cast below knee-toe", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply short leg cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29425 application short leg cast walking type", "code_information": [ { "code": "29425", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Apply short leg cast", "code_information": [ { "code": "29425", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29440 adding walker previously applied cast tech fee", "code_information": [ { "code": "29440", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Addition of walker to cast", "code_information": [ { "code": "29440", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29505 application long leg splint thigh ankle/toes techfee", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application long leg splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29515 application short leg splint calf foot techfee", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Application lower leg splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29530 strapping knee techfee", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of knee", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29540 strapping ankle &/foot techfee", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of ankle and/or ft", "code_information": [ { "code": "29540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29550 strapping toes techfee", "code_information": [ { "code": "29550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strapping of toes", "code_information": [ { "code": "29550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29700 removal/bivalving gauntlet boot/body cast", "code_information": [ { "code": "29700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal/revision of cast", "code_information": [ { "code": "29700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 791.00, "discounted_cash": 791.00, "minimum": 272.96, "maximum": 287.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 272.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 287.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "29799 unlisted procedure casting/strapping techfee", "code_information": [ { "code": "29799", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Casting/strapping procedure", "code_information": [ { "code": "29799", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 460.00, "discounted_cash": 460.00, "minimum": 162.18, "maximum": 170.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 170.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29824", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19303.32, "discounted_cash": 19303.32, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29824", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19303.32, "discounted_cash": 19303.32, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29826", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21166.23, "discounted_cash": 21166.23, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shoulder arthroscopy/surgery", "code_information": [ { "code": "29826", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21166.23, "discounted_cash": 21166.23, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscop rotator cuff repr", "code_information": [ { "code": "29827", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19627.81, "discounted_cash": 19627.81, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Arthroscop rotator cuff repr", "code_information": [ { "code": "29827", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 19627.81, "discounted_cash": 19627.81, "minimum": 7342.31, "maximum": 7728.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29877", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14163.96, "discounted_cash": 14163.96, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29877", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14163.96, "discounted_cash": 14163.96, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17220.74, "discounted_cash": 17220.74, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 17220.74, "discounted_cash": 17220.74, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29881", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18065.74, "discounted_cash": 18065.74, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Knee arthroscopy/surgery", "code_information": [ { "code": "29881", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12292.96, "discounted_cash": 12292.96, "minimum": 3334.80, "maximum": 3510.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3334.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3510.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "30300 fb removal nose techfee", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove nasal foreign body", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "30901 nasal pack/cautery simpl techfee", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Control of nosebleed", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "30903 nasal pack ant comp rockt techfee", "code_information": [ { "code": "30903", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Control of nosebleed", "code_information": [ { "code": "30903", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "30905 nasal hem cont post&ant techfee", "code_information": [ { "code": "30905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Control of nosebleed", "code_information": [ { "code": "30905", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "30906 cntrl nosebleed-subs ed tech fee", "code_information": [ { "code": "30906", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 701.00, "discounted_cash": 701.00, "minimum": 238.68, "maximum": 251.24, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repeat control of nosebleed", "code_information": [ { "code": "30906", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 701.00, "discounted_cash": 701.00, "minimum": 238.68, "maximum": 251.24, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "31500 intubation/et tube insert techfee", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 701.00, "discounted_cash": 701.00, "minimum": 238.68, "maximum": 251.24, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert emergency airway", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 701.00, "discounted_cash": 701.00, "minimum": 238.68, "maximum": 251.24, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "31603 incision of windpipe ed tech fee", "code_information": [ { "code": "31603", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4645.00, "discounted_cash": 4645.00, "minimum": 1522.46, "maximum": 1602.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of windpipe", "code_information": [ { "code": "31603", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4645.00, "discounted_cash": 4645.00, "minimum": 1522.46, "maximum": 1602.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "32551 thoracostomy chest tube placement", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3366.00, "discounted_cash": 3366.00, "minimum": 1596.62, "maximum": 1680.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insertion of chest tube", "code_information": [ { "code": "32551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3366.00, "discounted_cash": 3366.00, "minimum": 1596.62, "maximum": 1680.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "32554 thoracentesis needle/cath pleura w/o imaging techfee", "code_information": [ { "code": "32554", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2171.00, "discounted_cash": 2171.00, "minimum": 635.45, "maximum": 668.89, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspirate pleura w/o imaging", "code_information": [ { "code": "32554", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2171.00, "discounted_cash": 2171.00, "minimum": 635.45, "maximum": 668.89, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "32555 thoracentesis needle or catheter aspiration of the pleural space techfee", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2171.00, "discounted_cash": 2171.00, "minimum": 635.45, "maximum": 668.89, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspirate pleura w/ imaging", "code_information": [ { "code": "32555", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2171.00, "discounted_cash": 2171.00, "minimum": 635.45, "maximum": 668.89, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "32556 perq drainage pleura insert cath w/o imaging techfee", "code_information": [ { "code": "32556", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1787.00, "discounted_cash": 1787.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert cath pleura w/o image", "code_information": [ { "code": "32556", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1787.00, "discounted_cash": 1787.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "35656 bypass graft w/other than vein femoral-popliteal-lchn", "code_information": [ { "code": "35656", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3383.00, "discounted_cash": 3383.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Art byp femoral-popliteal", "code_information": [ { "code": "35656", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3383.00, "discounted_cash": 3383.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "36000 lace needle in vein ed tech fee", "code_information": [ { "code": "36000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 103.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Place needle in vein", "code_information": [ { "code": "36000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35214.57, "discounted_cash": 35214.57, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Place needle in vein", "code_information": [ { "code": "36000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 103.00, "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Place catheter in vein", "code_information": [ { "code": "36010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35214.57, "discounted_cash": 35214.57, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Collection: venous draw", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Routine venipuncture", "code_information": [ { "code": "36415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Capillary blood draw", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Collection: capillary", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "1-4 hours - blood administration charges", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1224.00, "discounted_cash": 1224.00, "minimum": 449.33, "maximum": 472.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 472.98, "count": "1 through 10", "median_amount": 547.19, "10th_percentile": 547.19, "90th_percentile": 547.19, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood transfusion service", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24229.54, "discounted_cash": 24229.54, "minimum": 449.33, "maximum": 472.98, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 472.98, "count": "1 through 10", "median_amount": 547.19, "10th_percentile": 547.19, "90th_percentile": 547.19, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood transfusion service", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1224.00, "discounted_cash": 1224.00, "minimum": 449.33, "maximum": 472.98, "setting": "outpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 472.98, "count": "1 through 10", "median_amount": 547.19, "10th_percentile": 547.19, "90th_percentile": 547.19, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bl push transfuse 2 yr/<", "code_information": [ { "code": "36440", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24229.54, "discounted_cash": 24229.54, "minimum": 449.33, "maximum": 472.98, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 449.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 472.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "36556 insert nontunneled centrally inserted central cath age 5 or older-lchn", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9585.00, "discounted_cash": 9585.00, "minimum": 3234.99, "maximum": 3405.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3405.26, "count": "1 through 10", "median_amount": 2935.86, "10th_percentile": 2935.86, "90th_percentile": 2935.86, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert non-tunnel cv cath", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9585.00, "discounted_cash": 9585.00, "minimum": 3234.99, "maximum": 3405.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3405.26, "count": "1 through 10", "median_amount": 2935.86, "10th_percentile": 2935.86, "90th_percentile": 2935.86, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36561", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11573.42, "discounted_cash": 11573.42, "minimum": 3234.99, "maximum": 3405.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "36566 insertion tunneled central line req 2 cath via 2 sites w/subcu port(s)-lchn", "code_information": [ { "code": "36566", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16358.00, "discounted_cash": 16358.00, "minimum": 5555.96, "maximum": 5848.38, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5555.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5555.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5555.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert tunneled cv cath", "code_information": [ { "code": "36566", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16358.00, "discounted_cash": 16358.00, "minimum": 5555.96, "maximum": 5848.38, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5555.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5555.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5555.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 5848.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "36569 insert picc cath techfee", "code_information": [ { "code": "36569", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5615.00, "discounted_cash": 5615.00, "minimum": 1596.62, "maximum": 1680.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insj picc 5 yr+ w/o imaging", "code_information": [ { "code": "36569", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5615.00, "discounted_cash": 5615.00, "minimum": 1596.62, "maximum": 1680.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "36571 bilat insert picvad cath charge", "code_information": [ { "code": "36571", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18963.00, "discounted_cash": 18963.00, "minimum": 3234.99, "maximum": 3405.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert picvad cath", "code_information": [ { "code": "36571", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 18963.00, "discounted_cash": 18963.00, "minimum": 3234.99, "maximum": 3405.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3234.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3405.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "36573 peripherally inserted central catheter w/imaging guidance ages 5 and older", "code_information": [ { "code": "36573", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4824.00, "discounted_cash": 4824.00, "minimum": 1596.62, "maximum": 1680.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insj picc rs&i 5 yr+", "code_information": [ { "code": "36573", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4824.00, "discounted_cash": 4824.00, "minimum": 1596.62, "maximum": 1680.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "36584 lt replacement complete of a peripherally inserted central venous catheter (picc)", "code_information": [ { "code": "36584", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4736.00, "discounted_cash": 4736.00, "minimum": 1596.62, "maximum": 1680.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Compl rplcmt picc rs&i", "code_information": [ { "code": "36584", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4736.00, "discounted_cash": 4736.00, "minimum": 1596.62, "maximum": 1680.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1596.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1680.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal tunneled cv cath", "code_information": [ { "code": "36589", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7196.00, "discounted_cash": 7196.00, "minimum": 635.45, "maximum": 668.89, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 635.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 668.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "36591 er - collection blood thru catheter techfee", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Draw blood off venous device", "code_information": [ { "code": "36591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "36592 collect blood from catheter venous nos techfee", "code_information": [ { "code": "36592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "1 through 10", "median_amount": 160.29, "10th_percentile": 160.29, "90th_percentile": 160.29, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Collect blood from picc", "code_information": [ { "code": "36592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "1 through 10", "median_amount": 160.29, "10th_percentile": 160.29, "90th_percentile": 160.29, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "36593 declot vascular device ed tech fee", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1067.00, "discounted_cash": 1067.00, "minimum": 340.91, "maximum": 358.85, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Declot vascular device", "code_information": [ { "code": "36593", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1067.00, "discounted_cash": 1067.00, "minimum": 340.91, "maximum": 358.85, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Collection: arterial draw", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Withdrawal of arterial blood", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert needle bone cavity", "code_information": [ { "code": "36680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 1252.00, "minimum": 410.13, "maximum": 431.72, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tech ed 36680 placement needle intraosseous infusion techfee", "code_information": [ { "code": "36680", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 1252.00, "minimum": 410.13, "maximum": 431.72, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "37195 thrombolysis cerebral iv infusion techfee", "code_information": [ { "code": "37195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1067.00, "discounted_cash": 1067.00, "minimum": 340.91, "maximum": 358.85, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thrombolytic therapy stroke", "code_information": [ { "code": "37195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1067.00, "discounted_cash": 1067.00, "minimum": 340.91, "maximum": 358.85, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "40650 rpr lip full thickness vermilion only techfee", "code_information": [ { "code": "40650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1558.00, "discounted_cash": 1558.00, "minimum": 523.41, "maximum": 550.95, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair lip", "code_information": [ { "code": "40650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1558.00, "discounted_cash": 1558.00, "minimum": 523.41, "maximum": 550.95, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "40800 drain mouth lesion ed tech fee", "code_information": [ { "code": "40800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of mouth lesion", "code_information": [ { "code": "40800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "40830 closure laceration vestibule mouth 2.5 cm/< techfee", "code_information": [ { "code": "40830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 729.00, "discounted_cash": 729.00, "minimum": 238.68, "maximum": 251.24, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair mouth laceration", "code_information": [ { "code": "40830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 729.00, "discounted_cash": 729.00, "minimum": 238.68, "maximum": 251.24, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 238.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 251.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "40831 closure lac vestibule of mouth; over 2.5cm or complex", "code_information": [ { "code": "40831", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1669.00, "discounted_cash": 1669.00, "minimum": 523.41, "maximum": 550.95, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Repair mouth laceration", "code_information": [ { "code": "40831", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1669.00, "discounted_cash": 1669.00, "minimum": 523.41, "maximum": 550.95, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 523.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 550.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "41800 drainage of gum lesi ed tech fee", "code_information": [ { "code": "41800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of gum lesion", "code_information": [ { "code": "41800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "42809 rmv frgn body-pharyn ed tech fee", "code_information": [ { "code": "42809", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 1252.00, "minimum": 410.13, "maximum": 431.72, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove pharynx foreign body", "code_information": [ { "code": "42809", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 1252.00, "minimum": 410.13, "maximum": 431.72, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "42820 tonsillectomy/adenoidectomy younger than age 12", "code_information": [ { "code": "42820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16995.00, "discounted_cash": 16995.00, "minimum": 6080.10, "maximum": 6400.11, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 6080.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 6080.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 6080.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove tonsils and adenoids", "code_information": [ { "code": "42820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16995.00, "discounted_cash": 16995.00, "minimum": 6080.10, "maximum": 6400.11, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 6080.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 6080.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 6080.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6400.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "42821 tonsillectomy/adenoidectomy age 12 and over", "code_information": [ { "code": "42821", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9056.00, "discounted_cash": 9056.00, "minimum": 3333.22, "maximum": 3508.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove tonsils and adenoids", "code_information": [ { "code": "42821", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9056.00, "discounted_cash": 9056.00, "minimum": 3333.22, "maximum": 3508.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "42826 tonsillectomy age 12 or over-lchn", "code_information": [ { "code": "42826", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9056.00, "discounted_cash": 9056.00, "minimum": 3333.22, "maximum": 3508.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of tonsils", "code_information": [ { "code": "42826", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9056.00, "discounted_cash": 9056.00, "minimum": 3333.22, "maximum": 3508.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3333.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3508.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "43220 esophagoscopy w/transendo balloon dilation < 30mm", "code_information": [ { "code": "43220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5543.00, "discounted_cash": 5543.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagoscopy balloon <30mm", "code_information": [ { "code": "43220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5543.00, "discounted_cash": 5543.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy endoscopic ultrasound", "code_information": [ { "code": "43231", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagoscop ultrasound exam", "code_information": [ { "code": "43231", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd balloon dil esoph30 mm/>", "code_information": [ { "code": "43233", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy balloon dilatation", "code_information": [ { "code": "43233", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd diagnostic brush wash", "code_information": [ { "code": "43235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6858.59, "discounted_cash": 6858.59, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "12", "median_amount": 674.52, "10th_percentile": 58.49, "90th_percentile": 2284.99, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy injection therapeutic agent", "code_information": [ { "code": "43236", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2710.00, "discounted_cash": 2710.00, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Uppr gi scope w/submuc inj", "code_information": [ { "code": "43236", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2710.00, "discounted_cash": 2710.00, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd biopsy single/multiple", "code_information": [ { "code": "43239", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7103.56, "discounted_cash": 7103.56, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "16", "median_amount": 628.60, "10th_percentile": 59.98, "90th_percentile": 2451.32, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd tube/cath insertion", "code_information": [ { "code": "43241", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy with catheter placement", "code_information": [ { "code": "43241", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd injection varices", "code_information": [ { "code": "43243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy sclerotherapy", "code_information": [ { "code": "43243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd varices ligation", "code_information": [ { "code": "43244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8716.00, "discounted_cash": 8716.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy with variceal banding", "code_information": [ { "code": "43244", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8716.00, "discounted_cash": 8716.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd dilate stricture", "code_information": [ { "code": "43245", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2710.00, "discounted_cash": 2710.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy gastric outlet dilatation", "code_information": [ { "code": "43245", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2710.00, "discounted_cash": 2710.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd place gastrostomy tube", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy with peg placement", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd remove foreign body", "code_information": [ { "code": "43247", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2710.00, "discounted_cash": 2710.00, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy foreign body removal", "code_information": [ { "code": "43247", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2710.00, "discounted_cash": 2710.00, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd guide wire insertion", "code_information": [ { "code": "43248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2710.00, "discounted_cash": 2710.00, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy guided dilatation", "code_information": [ { "code": "43248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2710.00, "discounted_cash": 2710.00, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esoph egd dilation <30 mm", "code_information": [ { "code": "43249", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10177.63, "discounted_cash": 10177.63, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "1 through 10", "median_amount": 1866.98, "10th_percentile": 94.42, "90th_percentile": 3639.53, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "1 through 10", "median_amount": 133.98, "10th_percentile": 133.98, "90th_percentile": 133.98, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "43250 esophagogastroduodenoscopy flexible transoral; with removal of tumor(s) polyp(s) or other", "code_information": [ { "code": "43250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd cautery tumor polyp", "code_information": [ { "code": "43250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "43251 esophagogastroduodenoscopy flexible transoral; with removal of tumor(s) polyp(s) or other", "code_information": [ { "code": "43251", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd remove lesion snare", "code_information": [ { "code": "43251", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Egd control bleeding any", "code_information": [ { "code": "43255", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esophagogastroduodenoscopy control bleeding", "code_information": [ { "code": "43255", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dilate esophagus 1/mult pass", "code_information": [ { "code": "43450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6671.50, "discounted_cash": 6671.50, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "43752 naso-or oro-gastric tube", "code_information": [ { "code": "43752", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 1252.00, "minimum": 410.13, "maximum": 431.72, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nasal/orogastric w/tube plmt", "code_information": [ { "code": "43752", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 1252.00, "minimum": 410.13, "maximum": 431.72, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lavage gastric", "code_information": [ { "code": "43753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 887.00, "discounted_cash": 887.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx gastro intub w/asp", "code_information": [ { "code": "43753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 887.00, "discounted_cash": 887.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "43761 repositioning naogastric tube", "code_information": [ { "code": "43761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 730.00, "discounted_cash": 730.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Reposition gastrostomy tube", "code_information": [ { "code": "43761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 730.00, "discounted_cash": 730.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rplc gtube no revj trc", "code_information": [ { "code": "43762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1887.00, "discounted_cash": 1887.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "1 through 10", "median_amount": 410.39, "10th_percentile": 410.39, "90th_percentile": 410.39, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy stoma", "code_information": [ { "code": "44388", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2657.00, "discounted_cash": 2657.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy thru stoma spx", "code_information": [ { "code": "44388", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2657.00, "discounted_cash": 2657.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy biopsy stoma", "code_information": [ { "code": "44389", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy with biopsy", "code_information": [ { "code": "44389", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy for foreign body", "code_information": [ { "code": "44390", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2657.00, "discounted_cash": 2657.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy foreign body removal stoma", "code_information": [ { "code": "44390", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2657.00, "discounted_cash": 2657.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy control bleeding stoma", "code_information": [ { "code": "44391", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy for bleeding", "code_information": [ { "code": "44391", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "44394 colonoscopy through stoma; with removal of tumor(s) polyp(s) or other lesion(s) by snare tec", "code_information": [ { "code": "44392", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy & polypectomy", "code_information": [ { "code": "44392", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "44394 open tx humeral supracondylar/transcondylar fx incl int fixatn w/intercond ext", "code_information": [ { "code": "44394", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/snare", "code_information": [ { "code": "44394", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "44401 colonoscopy through stoma; with ablation of tumor(s) polyp(s) or other lesion(s) (includes p", "code_information": [ { "code": "44401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy with ablation", "code_information": [ { "code": "44401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diagnostic sigmoidoscopy", "code_information": [ { "code": "45330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2733.00, "discounted_cash": 2733.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy diagnostic", "code_information": [ { "code": "45330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2733.00, "discounted_cash": 2733.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy and biopsy", "code_information": [ { "code": "45331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2847.00, "discounted_cash": 2847.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy biopsy", "code_information": [ { "code": "45331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2847.00, "discounted_cash": 2847.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy removal foreign body", "code_information": [ { "code": "45332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy w/fb removal", "code_information": [ { "code": "45332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "45333 sigmoidoscopy flexible; with removal of tumor(s) polyp(s) or other lesion(s) by hot biopsy", "code_information": [ { "code": "45333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 976.00, "discounted_cash": 976.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy & polypectomy", "code_information": [ { "code": "45333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 976.00, "discounted_cash": 976.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy control bleeding", "code_information": [ { "code": "45334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy for bleeding", "code_information": [ { "code": "45334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "45338 sigmoidoscopy flexible; with removal of tumor(s) polyp(s) or other lesion(s) by snare techn", "code_information": [ { "code": "45338", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 861.00, "discounted_cash": 861.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sigmoidoscopy w/tumr remove", "code_information": [ { "code": "45338", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 861.00, "discounted_cash": 861.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "45350 sigmoidoscopy flexible; diag w/band ligation(s)", "code_information": [ { "code": "45350", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3447.00, "discounted_cash": 3447.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sgmdsc w/band ligation", "code_information": [ { "code": "45350", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3447.00, "discounted_cash": 3447.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diagnostic colonoscopy", "code_information": [ { "code": "45378", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5380.76, "discounted_cash": 5380.76, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "1 through 10", "median_amount": 161.17, "10th_percentile": 161.17, "90th_percentile": 1188.35, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy foreign body removal", "code_information": [ { "code": "45379", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/fb removal", "code_information": [ { "code": "45379", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy and biopsy", "code_information": [ { "code": "45380", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6974.61, "discounted_cash": 6974.61, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy control bleeding", "code_information": [ { "code": "45382", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/control bleed", "code_information": [ { "code": "45382", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/lesion removal", "code_information": [ { "code": "45384", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9028.56, "discounted_cash": 9028.56, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/lesion removal", "code_information": [ { "code": "45385", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9572.69, "discounted_cash": 9572.69, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy dilatation", "code_information": [ { "code": "45386", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/balloon dilat", "code_information": [ { "code": "45386", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "45388 colonoscopy flexible; with ablation of tumor(s) polyp(s) or other lesion", "code_information": [ { "code": "45388", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/ablation", "code_information": [ { "code": "45388", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "45390 colonoscopy w/lesion ablation/removal w/mucosal resection", "code_information": [ { "code": "45390", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8172.00, "discounted_cash": 8172.00, "minimum": 2818.62, "maximum": 2966.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/resection", "code_information": [ { "code": "45390", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8172.00, "discounted_cash": 8172.00, "minimum": 2818.62, "maximum": 2966.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy decompression", "code_information": [ { "code": "45393", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/decompression", "code_information": [ { "code": "45393", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3472.00, "discounted_cash": 3472.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colonoscopy w/band ligation", "code_information": [ { "code": "45398", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3646.00, "discounted_cash": 3646.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hemorrhoid banding", "code_information": [ { "code": "45398", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3646.00, "discounted_cash": 3646.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Examination under anesthesia rectum", "code_information": [ { "code": "45990", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2657.00, "discounted_cash": 2657.00, "minimum": 2818.62, "maximum": 2966.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Surg dx exam anorectal", "code_information": [ { "code": "45990", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2657.00, "discounted_cash": 2657.00, "minimum": 2818.62, "maximum": 2966.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "46040 incis. rectal absces ed tech fee", "code_information": [ { "code": "46040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3458.00, "discounted_cash": 3458.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of rectal abscess", "code_information": [ { "code": "46040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3458.00, "discounted_cash": 3458.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "46083 incis thromb. hemorr ed tech fee", "code_information": [ { "code": "46083", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 810.00, "discounted_cash": 810.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incise external hemorrhoid", "code_information": [ { "code": "46083", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 810.00, "discounted_cash": 810.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "46221 hemorrhoidectomy internal by rubberband ligation(s)", "code_information": [ { "code": "46221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2772.00, "discounted_cash": 2772.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ligation of hemorrhoid(s)", "code_information": [ { "code": "46221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2772.00, "discounted_cash": 2772.00, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove anal fist inter", "code_information": [ { "code": "46275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7888.46, "discounted_cash": 7888.46, "minimum": 2818.62, "maximum": 2966.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenervation anal musc", "code_information": [ { "code": "46505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3458.00, "discounted_cash": 3458.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Injection neurotoxin agent intramuscular anus", "code_information": [ { "code": "46505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3458.00, "discounted_cash": 3458.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "46600 anoscopy diagnostic ed tech fee", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diagnostic anoscopy spx", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anoscopy", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3579.00, "discounted_cash": 3579.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anoscopy and biopsy", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3579.00, "discounted_cash": 3579.00, "minimum": 1211.86, "maximum": 1275.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1211.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1275.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "46900 destruction of lesion(s) anus simple; chemical", "code_information": [ { "code": "46900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1158.00, "discounted_cash": 1158.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destruction anal lesion(s)", "code_information": [ { "code": "46900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1158.00, "discounted_cash": 1158.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "46910 destruction of lesion(s) anus simple electrodesiccation", "code_information": [ { "code": "46910", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5735.00, "discounted_cash": 5735.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destruction anal lesion(s)", "code_information": [ { "code": "46910", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5735.00, "discounted_cash": 5735.00, "minimum": 1880.08, "maximum": 1979.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1880.08, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1979.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "46940 curettage/cautery anal fissue initial", "code_information": [ { "code": "46940", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5543.00, "discounted_cash": 5543.00, "minimum": 2818.62, "maximum": 2966.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of anal fissure", "code_information": [ { "code": "46940", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5543.00, "discounted_cash": 5543.00, "minimum": 2818.62, "maximum": 2966.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2818.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2966.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Laparoscopic cholecystectomy", "code_information": [ { "code": "47562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 20591.14, "discounted_cash": 20591.14, "minimum": 5996.54, "maximum": 6312.15, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6312.15, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abd paracentesis", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2749.00, "discounted_cash": 2749.00, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Paracentesis abdominal", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2749.00, "discounted_cash": 2749.00, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "49083 incision procedures on the abdomen peritoneum and omentum techfee", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2787.00, "discounted_cash": 2787.00, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abd paracentesis w/imaging", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2787.00, "discounted_cash": 2787.00, "minimum": 963.62, "maximum": 1014.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 963.62, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1014.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Excise sacral spine tumor", "code_information": [ { "code": "49215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gastrotomy with feeding tube insertion", "code_information": [ { "code": "49440", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Place gastrostomy tube perc", "code_information": [ { "code": "49440", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5438.00, "discounted_cash": 5438.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "49446 conv g-tube to gastrojejunostomy tube under fluro guidance-lchn", "code_information": [ { "code": "49446", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5543.00, "discounted_cash": 5543.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Change g-tube to g-j perc", "code_information": [ { "code": "49446", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5543.00, "discounted_cash": 5543.00, "minimum": 1949.72, "maximum": 2052.34, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1949.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2052.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prp i/hern init reduc >5 yr", "code_information": [ { "code": "49505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16410.49, "discounted_cash": 16410.49, "minimum": 3627.16, "maximum": 3818.06, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prp i/hern init reduc >5 yr", "code_information": [ { "code": "49505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16410.49, "discounted_cash": 16410.49, "minimum": 3627.16, "maximum": 3818.06, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prp i/hern init reduc >5 yr", "code_information": [ { "code": "49505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12500.33, "discounted_cash": 12500.33, "minimum": 3627.16, "maximum": 3818.06, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3818.06, "count": "1 through 10", "median_amount": 1964.17, "10th_percentile": 457.73, "90th_percentile": 3470.62, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prp i/hern init reduc >5 yr", "code_information": [ { "code": "49505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14408.44, "discounted_cash": 14408.44, "minimum": 3627.16, "maximum": 3818.06, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "49520 repair recurrent inguinal hernia techfee", "code_information": [ { "code": "49520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4234.00, "discounted_cash": 4234.00, "minimum": 3627.16, "maximum": 3818.06, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rerepair ing hernia reduce", "code_information": [ { "code": "49520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4234.00, "discounted_cash": 4234.00, "minimum": 3627.16, "maximum": 3818.06, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn 1st < 3 cm rdc", "code_information": [ { "code": "49591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14421.90, "discounted_cash": 14421.90, "minimum": 3627.16, "maximum": 3818.06, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3818.06, "count": "1 through 10", "median_amount": 1712.14, "10th_percentile": 299.11, "90th_percentile": 3125.17, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3627.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3818.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "49592 repair ant abd hernia(s) less than 3cm incarcerated/strangulated", "code_information": [ { "code": "49592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16589.00, "discounted_cash": 16589.00, "minimum": 5996.54, "maximum": 6312.15, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn 1st < 3 ncr/strn", "code_information": [ { "code": "49592", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16589.00, "discounted_cash": 16589.00, "minimum": 5996.54, "maximum": 6312.15, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn 1st 3-10 rdc", "code_information": [ { "code": "49593", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12952.29, "discounted_cash": 12952.29, "minimum": 6413.20, "maximum": 6750.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 6413.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 6413.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 6413.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "49594 repair ant abd hernia(s) 3-10cm incarcerated/strangulated", "code_information": [ { "code": "49594", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16589.00, "discounted_cash": 16589.00, "minimum": 5996.54, "maximum": 6312.15, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn 1st 3-10 ncr/strn", "code_information": [ { "code": "49594", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16589.00, "discounted_cash": 16589.00, "minimum": 5996.54, "maximum": 6312.15, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5996.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6312.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "49595 repair ant abd hernia(s) greater than 10cm reducible", "code_information": [ { "code": "49595", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11273.00, "discounted_cash": 11273.00, "minimum": 6413.20, "maximum": 6750.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 6413.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 6413.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 6413.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rpr aa hrn 1st > 10 rdc", "code_information": [ { "code": "49595", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 11273.00, "discounted_cash": 11273.00, "minimum": 6413.20, "maximum": 6750.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 6413.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 6413.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 6413.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6750.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "51100 aspiration bladder ndl techfee", "code_information": [ { "code": "51100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 810.00, "discounted_cash": 810.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain bladder by needle", "code_information": [ { "code": "51100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 810.00, "discounted_cash": 810.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "51102 aspiration bladder insert suprapubic catheter techfee", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain bl w/cath insertion", "code_information": [ { "code": "51102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "51700 irrigate bladder ed tech fee", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 810.00, "discounted_cash": 810.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Irrigation of bladder", "code_information": [ { "code": "51700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 810.00, "discounted_cash": 810.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "51701 insertion of non-indwelling bladder catheter", "code_information": [ { "code": "51701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 411.00, "discounted_cash": 411.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "1 through 10", "median_amount": 46.60, "10th_percentile": 23.58, "90th_percentile": 69.62, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert bladder catheter", "code_information": [ { "code": "51701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 411.00, "discounted_cash": 411.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "1 through 10", "median_amount": 46.60, "10th_percentile": 23.58, "90th_percentile": 69.62, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "51702 insertion of temporary indwelling bladder catheter; simple", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 388.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "42", "median_amount": 21.74, "10th_percentile": 20.42, "90th_percentile": 173.65, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert temp bladder cath", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14815.00, "discounted_cash": 14815.00, "minimum": 132.48, "maximum": 139.46, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "42", "median_amount": 21.74, "10th_percentile": 20.42, "90th_percentile": 173.65, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert temp bladder cath", "code_information": [ { "code": "51702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 388.00, "minimum": 132.48, "maximum": 139.46, "setting": "outpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "42", "median_amount": 21.74, "10th_percentile": 20.42, "90th_percentile": 173.65, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "51703 foley catheter complicated (balloon)", "code_information": [ { "code": "51703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 477.00, "discounted_cash": 477.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert bladder cath complex", "code_information": [ { "code": "51703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14815.00, "discounted_cash": 14815.00, "minimum": 160.81, "maximum": 169.27, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insert bladder cath complex", "code_information": [ { "code": "51703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 477.00, "discounted_cash": 477.00, "minimum": 160.81, "maximum": 169.27, "setting": "outpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "51705 change cystostomy tube simple pro/tech", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 916.00, "discounted_cash": 916.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Change of bladder tube", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 916.00, "discounted_cash": 916.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy injection collagen", "code_information": [ { "code": "51715", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10294.00, "discounted_cash": 10294.00, "minimum": 3544.84, "maximum": 3731.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Endoscopic injection/implant", "code_information": [ { "code": "51715", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10294.00, "discounted_cash": 10294.00, "minimum": 3544.84, "maximum": 3731.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "51720 insertion of temporary indwelling bladder catheter; simple", "code_information": [ { "code": "51720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 388.00, "minimum": 686.02, "maximum": 722.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of bladder lesion", "code_information": [ { "code": "51720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 388.00, "minimum": 686.02, "maximum": 722.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "51798 ed tech bladder scan", "code_information": [ { "code": "51798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us urine capacity measure", "code_information": [ { "code": "51798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1927.00, "discounted_cash": 1927.00, "minimum": 686.02, "maximum": 722.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy flexible", "code_information": [ { "code": "52000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1927.00, "discounted_cash": 1927.00, "minimum": 686.02, "maximum": 722.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 686.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 722.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy evacuation clots", "code_information": [ { "code": "52001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10294.00, "discounted_cash": 10294.00, "minimum": 3544.84, "maximum": 3731.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy removal of clots", "code_information": [ { "code": "52001", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10294.00, "discounted_cash": 10294.00, "minimum": 3544.84, "maximum": 3731.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy & ureter catheter", "code_information": [ { "code": "52005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5996.00, "discounted_cash": 5996.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy instillation therapeutic agent", "code_information": [ { "code": "52005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5996.00, "discounted_cash": 5996.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy biopsy", "code_information": [ { "code": "52204", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5996.00, "discounted_cash": 5996.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy w/biopsy(s)", "code_information": [ { "code": "52204", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5996.00, "discounted_cash": 5996.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy chemodenervation", "code_information": [ { "code": "52287", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5996.00, "discounted_cash": 5996.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy with injection therapeutic agent", "code_information": [ { "code": "52287", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5996.00, "discounted_cash": 5996.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy and treatment", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5996.00, "discounted_cash": 5996.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy foreign body removal", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5996.00, "discounted_cash": 5996.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystoscopy stone extraction", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10294.00, "discounted_cash": 10294.00, "minimum": 3544.84, "maximum": 3731.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cystouretero w/stone remove", "code_information": [ { "code": "52352", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10294.00, "discounted_cash": 10294.00, "minimum": 3544.84, "maximum": 3731.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3544.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3731.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "53020 meatotmy cutting meatus techfee", "code_information": [ { "code": "53020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incision of urethra", "code_information": [ { "code": "53020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "53265 exc/fulguration urtl caru techfee", "code_information": [ { "code": "53265", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of urethra lesion", "code_information": [ { "code": "53265", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "53600 dilat urtl strix male 1st techfee", "code_information": [ { "code": "53600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 810.00, "discounted_cash": 810.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dilate urethra stricture", "code_information": [ { "code": "53600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 810.00, "discounted_cash": 810.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "54150 circ w clamp w block techfee", "code_information": [ { "code": "54150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Circumcision w/regionl block", "code_information": [ { "code": "54150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "54220 irrigation of corpora cavernosa for priapism", "code_information": [ { "code": "54220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 684.00, "discounted_cash": 684.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of penis lesion", "code_information": [ { "code": "54220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 684.00, "discounted_cash": 684.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "54450 foreskin manipulation inclu lysis of preputial adhesions/stretching", "code_information": [ { "code": "54450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 684.00, "discounted_cash": 684.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Preputial stretching", "code_information": [ { "code": "54450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 684.00, "discounted_cash": 684.00, "minimum": 249.97, "maximum": 263.13, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 263.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "54700 i&d epididymis tstis/scro techfee", "code_information": [ { "code": "54700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of scrotum", "code_information": [ { "code": "54700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "55100 drainage scrotal wall abscess", "code_information": [ { "code": "55100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4773.00, "discounted_cash": 4773.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of scrotum abscess", "code_information": [ { "code": "55100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4773.00, "discounted_cash": 4773.00, "minimum": 1665.28, "maximum": 1752.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1665.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1752.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "55250 vasect uni/bi spx w/po techfee", "code_information": [ { "code": "55250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Removal of sperm duct(s)", "code_information": [ { "code": "55250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6099.00, "discounted_cash": 6099.00, "minimum": 2105.45, "maximum": 2216.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2105.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2216.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "56405 inc. &drain abscess ed tech fee", "code_information": [ { "code": "56405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 932.00, "discounted_cash": 932.00, "minimum": 312.65, "maximum": 329.10, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 312.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 312.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 312.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "I & d of vulva/perineum", "code_information": [ { "code": "56405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 932.00, "discounted_cash": 932.00, "minimum": 312.65, "maximum": 329.10, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 312.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 312.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 312.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 329.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "58100 endometrial bx w/wo endocervix bx w/o dilat spx tech fee", "code_information": [ { "code": "58100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 550.00, "discounted_cash": 550.00, "minimum": 206.76, "maximum": 217.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 206.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 206.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 206.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Biopsy of uterus lining", "code_information": [ { "code": "58100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 550.00, "discounted_cash": 550.00, "minimum": 206.76, "maximum": 217.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 206.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 206.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 206.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 217.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "58600 lig/trnsxj flp tb abd/vag techfee", "code_information": [ { "code": "58600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8598.00, "discounted_cash": 8598.00, "minimum": 3267.91, "maximum": 3439.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Division of fallopian tube", "code_information": [ { "code": "58600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8598.00, "discounted_cash": 8598.00, "minimum": 3267.91, "maximum": 3439.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "59160 curettage postpartum techfee", "code_information": [ { "code": "59160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8598.00, "discounted_cash": 8598.00, "minimum": 3267.91, "maximum": 3439.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D & c after delivery", "code_information": [ { "code": "59160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8598.00, "discounted_cash": 8598.00, "minimum": 3267.91, "maximum": 3439.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "59812 tx incomplete abortion any trimester surgical techfee", "code_information": [ { "code": "59812", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8598.00, "discounted_cash": 8598.00, "minimum": 3267.91, "maximum": 3439.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Treatment of miscarriage", "code_information": [ { "code": "59812", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8598.00, "discounted_cash": 8598.00, "minimum": 3267.91, "maximum": 3439.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "59820 treatment of missed abortion completed surgically; first trimester techfee", "code_information": [ { "code": "59820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8598.00, "discounted_cash": 8598.00, "minimum": 3267.91, "maximum": 3439.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Care of miscarriage", "code_information": [ { "code": "59820", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8598.00, "discounted_cash": 8598.00, "minimum": 3267.91, "maximum": 3439.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3267.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3439.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "62270 lumbar puncture", "code_information": [ { "code": "62270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1383.00, "discounted_cash": 1383.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx lmbr spi pnxr", "code_information": [ { "code": "62270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1383.00, "discounted_cash": 1383.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "62272 ther spi pnxr drg cst", "code_information": [ { "code": "62272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1553.00, "discounted_cash": 1553.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther spi pnxr drg csf", "code_information": [ { "code": "62272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1553.00, "discounted_cash": 1553.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "62273 njx edrl bld/clot patch techfee", "code_information": [ { "code": "62273", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2152.00, "discounted_cash": 2152.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inject epidural patch", "code_information": [ { "code": "62273", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2152.00, "discounted_cash": 2152.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "62320 injection; intrlamnr crv/thrc w/o image", "code_information": [ { "code": "62320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2152.00, "discounted_cash": 2152.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx interlaminar crv/thrc", "code_information": [ { "code": "62320", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2152.00, "discounted_cash": 2152.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx interlaminar crv/thrc", "code_information": [ { "code": "62321", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2920.58, "discounted_cash": 2920.58, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "62322 injection intrlamnr lumbar/sac w/o image", "code_information": [ { "code": "62322", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2152.00, "discounted_cash": 2152.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx interlaminar lmbr/sac", "code_information": [ { "code": "62322", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2152.00, "discounted_cash": 2152.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx interlaminar lmbr/sac", "code_information": [ { "code": "62323", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2722.60, "discounted_cash": 2722.60, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "1 through 10", "median_amount": 750.09, "10th_percentile": 545.81, "90th_percentile": 954.36, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "62328 lumbr spi pnxrw/flour/ct", "code_information": [ { "code": "62328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2051.00, "discounted_cash": 2051.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dx lmbr spi pnxr w/fluor/ct", "code_information": [ { "code": "62328", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2051.00, "discounted_cash": 2051.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove spine lamina 1/2 scrl", "code_information": [ { "code": "63011", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "minimum": 7342.31, "maximum": 7728.74, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 7342.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 7728.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Incise spine nrv half segmnt", "code_information": [ { "code": "63185", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "setting": "inpatient", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Implant neuroelectrodes", "code_information": [ { "code": "63655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35667.56, "discounted_cash": 35667.56, "minimum": 22040.49, "maximum": 23200.52, "setting": "inpatient", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 22040.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 22040.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 22040.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 23200.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64400 bilat injection anesthetic agent; trigeminal nerve any division or branch", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5681.00, "discounted_cash": 5681.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd trigeminal nrv", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5681.00, "discounted_cash": 5681.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64405 bilat greater ocicipital n", "code_information": [ { "code": "64405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2250.00, "discounted_cash": 2250.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd gr ocpl nrv", "code_information": [ { "code": "64405", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2250.00, "discounted_cash": 2250.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd axillary nrv", "code_information": [ { "code": "64417", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2875.00, "discounted_cash": 2875.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd axillary nrv", "code_information": [ { "code": "64417", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2875.00, "discounted_cash": 2875.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "1 through 10", "median_amount": 400.48, "10th_percentile": 129.39, "90th_percentile": 671.56, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd sprscap nrv", "code_information": [ { "code": "64418", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2875.00, "discounted_cash": 2875.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd sprscap nrv", "code_information": [ { "code": "64418", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2875.00, "discounted_cash": 2875.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "1 through 10", "median_amount": 189.34, "10th_percentile": 59.04, "90th_percentile": 319.65, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64420 bilat injection anesthetic agent; intercostal nerve single", "code_information": [ { "code": "64420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3151.00, "discounted_cash": 3151.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd ntrcost nrv 1", "code_information": [ { "code": "64420", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3151.00, "discounted_cash": 3151.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64421 bilat injection anesthetic agent; intercostal nerves multiple regional block", "code_information": [ { "code": "64421", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4476.00, "discounted_cash": 4476.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd ntrcost nrv ea", "code_information": [ { "code": "64421", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4476.00, "discounted_cash": 4476.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd pudendal nerve", "code_information": [ { "code": "64430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9110.00, "discounted_cash": 9110.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd pudendal nerve", "code_information": [ { "code": "64430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9110.00, "discounted_cash": 9110.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64445 bilat injection anesthetic agent; sciatic nerve single", "code_information": [ { "code": "64445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3151.00, "discounted_cash": 3151.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd sciatic nerve", "code_information": [ { "code": "64445", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3151.00, "discounted_cash": 3151.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64447 inj anesthtic agent femoral nerve sngl techfee", "code_information": [ { "code": "64447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2152.00, "discounted_cash": 2152.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd femoral nerve", "code_information": [ { "code": "64447", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2152.00, "discounted_cash": 2152.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd other pn/branch", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2875.00, "discounted_cash": 2875.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd other pn/branch", "code_information": [ { "code": "64450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2875.00, "discounted_cash": 2875.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "1 through 10", "median_amount": 214.49, "10th_percentile": 58.83, "90th_percentile": 370.14, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64451 bilat njx aa&/strd nrv nrvtg si jt", "code_information": [ { "code": "64451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4101.00, "discounted_cash": 4101.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd nrv nrvtg si jt", "code_information": [ { "code": "64451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4101.00, "discounted_cash": 4101.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd gnclr nrv brnch", "code_information": [ { "code": "64454", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5973.00, "discounted_cash": 5973.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd gnclr nrv brnch", "code_information": [ { "code": "64454", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5973.00, "discounted_cash": 5973.00, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd gnclr nrv brnch", "code_information": [ { "code": "64454", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5072.50, "discounted_cash": 5072.50, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Njx aa&/strd gnclr nrv brnch", "code_information": [ { "code": "64454", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5287.33, "discounted_cash": 5287.33, "minimum": 711.77, "maximum": 749.23, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 711.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 749.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64455 bilat injection(s) anesthetic agent and/or steroid plantar common digital nerve(s)", "code_information": [ { "code": "64455", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1825.00, "discounted_cash": 1825.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block inj plantar digit", "code_information": [ { "code": "64455", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1825.00, "discounted_cash": 1825.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural l/s", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7947.46, "discounted_cash": 7947.46, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural l/s", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7947.46, "discounted_cash": 7947.46, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural l/s", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5745.00, "discounted_cash": 5745.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural l/s", "code_information": [ { "code": "64483", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6594.07, "discounted_cash": 6594.07, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "1 through 10", "median_amount": 1420.49, "10th_percentile": 783.94, "90th_percentile": 2057.04, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural add-on", "code_information": [ { "code": "64484", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4355.50, "discounted_cash": 4355.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural add-on", "code_information": [ { "code": "64484", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6294.40, "discounted_cash": 6294.40, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj foramen epidural add-on", "code_information": [ { "code": "64484", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7193.42, "discounted_cash": 7193.42, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 1 lev", "code_information": [ { "code": "64490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16167.00, "discounted_cash": 16167.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 1 lev", "code_information": [ { "code": "64490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9397.33, "discounted_cash": 9397.33, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 1 lev", "code_information": [ { "code": "64490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 16167.00, "discounted_cash": 16167.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 2 lev", "code_information": [ { "code": "64491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12130.50, "discounted_cash": 12130.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 2 lev", "code_information": [ { "code": "64491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3931.00, "discounted_cash": 3931.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 2 lev", "code_information": [ { "code": "64491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12130.50, "discounted_cash": 12130.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64492 bilat add levels", "code_information": [ { "code": "64492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2491.00, "discounted_cash": 2491.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt c/t 3 lev", "code_information": [ { "code": "64492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2491.00, "discounted_cash": 2491.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 1 lev", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8580.60, "discounted_cash": 8580.60, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 1 lev", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7726.29, "discounted_cash": 7726.29, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "1 through 10", "median_amount": 131.71, "10th_percentile": 131.71, "90th_percentile": 4115.53, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "12", "median_amount": 984.38, "10th_percentile": 121.18, "90th_percentile": 1973.91, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 1 lev", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8580.60, "discounted_cash": 8580.60, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "1 through 10", "median_amount": 1561.89, "10th_percentile": 1135.84, "90th_percentile": 1987.95, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 1 lev", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8550.00, "discounted_cash": 8550.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "1 through 10", "median_amount": 1561.89, "10th_percentile": 1135.84, "90th_percentile": 1987.95, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 2 lev", "code_information": [ { "code": "64494", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8580.60, "discounted_cash": 8580.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 2 lev", "code_information": [ { "code": "64494", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7459.63, "discounted_cash": 7459.63, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 2 lev", "code_information": [ { "code": "64494", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8580.60, "discounted_cash": 8580.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 2 lev", "code_information": [ { "code": "64494", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8453.20, "discounted_cash": 8453.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64495 bilat third level", "code_information": [ { "code": "64495", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2291.00, "discounted_cash": 2291.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj paravert f jnt l/s 3 lev", "code_information": [ { "code": "64495", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2291.00, "discounted_cash": 2291.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64505 bilat sphenopalatine ganglion", "code_information": [ { "code": "64505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2571.00, "discounted_cash": 2571.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block spenopalatine gangl", "code_information": [ { "code": "64505", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2571.00, "discounted_cash": 2571.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64510 stellate ganglion", "code_information": [ { "code": "64510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3146.00, "discounted_cash": 3146.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block stellate ganglion", "code_information": [ { "code": "64510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3146.00, "discounted_cash": 3146.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64517 superior hypogastric plexus", "code_information": [ { "code": "64517", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3146.00, "discounted_cash": 3146.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block inj hypogas plxs", "code_information": [ { "code": "64517", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3146.00, "discounted_cash": 3146.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64520 bilat injection anesthetic agent; lumbar or thoracic", "code_information": [ { "code": "64520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3730.00, "discounted_cash": 3730.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block lumbar/thoracic", "code_information": [ { "code": "64520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3730.00, "discounted_cash": 3730.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64530 celiac plexus", "code_information": [ { "code": "64530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3146.00, "discounted_cash": 3146.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N block inj celiac pelus", "code_information": [ { "code": "64530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3146.00, "discounted_cash": 3146.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenerv musc migraine", "code_information": [ { "code": "64615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 942.00, "discounted_cash": 942.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenervation of muscle(s) muscle(s) innervated by facial trigeminal cervical spinal and acces", "code_information": [ { "code": "64615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 942.00, "discounted_cash": 942.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenerv musc neck dyston", "code_information": [ { "code": "64616", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 942.00, "discounted_cash": 942.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemodenervation of muscle(s) neck muscle(s) excluding muscles of the larynx unilateral 64616", "code_information": [ { "code": "64616", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 942.00, "discounted_cash": 942.00, "minimum": 303.40, "maximum": 319.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 303.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 319.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dstrj nulyt agt gnclr nrv", "code_information": [ { "code": "64624", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7508.00, "discounted_cash": 7508.00, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dstrj nulyt agt gnclr nrv", "code_information": [ { "code": "64624", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7121.33, "discounted_cash": 7121.33, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy cerv/thor facet jnt", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6381.00, "discounted_cash": 6381.00, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy cerv/thor facet jnt", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6381.00, "discounted_cash": 6381.00, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64634 bilat c/t rf x", "code_information": [ { "code": "64634", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2305.00, "discounted_cash": 2305.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy c/th facet jnt addl", "code_information": [ { "code": "64634", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2305.00, "discounted_cash": 2305.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy lumb/sac facet jnt", "code_information": [ { "code": "64635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9495.58, "discounted_cash": 9495.58, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy lumb/sac facet jnt", "code_information": [ { "code": "64635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9495.58, "discounted_cash": 9495.58, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "1 through 10", "median_amount": 1079.99, "10th_percentile": 256.40, "90th_percentile": 2047.83, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy l/s facet jnt addl", "code_information": [ { "code": "64636", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10863.70, "discounted_cash": 10863.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy l/s facet jnt addl", "code_information": [ { "code": "64636", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10863.70, "discounted_cash": 10863.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "50", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Destroy l/s facet jnt addl", "code_information": [ { "code": "64636", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10552.77, "discounted_cash": 10552.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64640 bilat destruction by neurolytic agent; other peripheral nerve or branch", "code_information": [ { "code": "64640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6107.00, "discounted_cash": 6107.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Injection treatment of nerve", "code_information": [ { "code": "64640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 6107.00, "discounted_cash": 6107.00, "minimum": 915.04, "maximum": 963.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 915.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 963.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "64719 neuroplasty ulnar nerve at wrist", "code_information": [ { "code": "64719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1144.00, "discounted_cash": 1144.00, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Revise ulnar nerve at wrist", "code_information": [ { "code": "64719", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1144.00, "discounted_cash": 1144.00, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carpal tunnel surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 10205.83, "discounted_cash": 10205.83, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carpal tunnel surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9525.92, "discounted_cash": 9525.92, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "1 through 10", "median_amount": 2566.18, "10th_percentile": 2566.18, "90th_percentile": 2566.18, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carpal tunnel surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 9055.64, "discounted_cash": 9055.64, "minimum": 2007.05, "maximum": 2112.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2007.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2112.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "65205 removal fb eye conjunctival superficial techfee", "code_information": [ { "code": "65205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "65210 removal of external body external eye techfee", "code_information": [ { "code": "65210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 1252.00, "minimum": 410.13, "maximum": 431.72, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 1252.00, "minimum": 410.13, "maximum": 431.72, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "65220 remove fb corneal w/o techfee", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 1252.00, "minimum": 410.13, "maximum": 431.72, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1252.00, "discounted_cash": 1252.00, "minimum": 410.13, "maximum": 431.72, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 431.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "65222 rmvl fb xtrnl eye corneal w/slit lamp techfee", "code_information": [ { "code": "65222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove foreign body from eye", "code_information": [ { "code": "65222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "66821 laser surgery (eg yag laser) (1 or more stages)", "code_information": [ { "code": "66821", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1746.00, "discounted_cash": 1746.00, "minimum": 563.85, "maximum": 593.53, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 563.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 563.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 563.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "After cataract laser surgery", "code_information": [ { "code": "66821", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1746.00, "discounted_cash": 1746.00, "minimum": 563.85, "maximum": 593.53, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 563.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 563.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 563.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 593.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xcapsl ctrc rmvl w/o ecp", "code_information": [ { "code": "66984", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8637.33, "discounted_cash": 8637.33, "minimum": 2344.13, "maximum": 2467.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2344.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2344.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2344.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xcapsl ctrc rmvl w/o ecp", "code_information": [ { "code": "66984", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7983.44, "discounted_cash": 7983.44, "minimum": 2344.13, "maximum": 2467.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2467.50, "count": "1 through 10", "median_amount": 2214.26, "10th_percentile": 2184.63, "90th_percentile": 2243.89, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2344.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2344.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2344.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xcapsl ctrc rmvl w/o ecp", "code_information": [ { "code": "66984", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 8396.65, "discounted_cash": 8396.65, "minimum": 2344.13, "maximum": 2467.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2467.50, "count": "1 through 10", "median_amount": 2214.26, "10th_percentile": 2214.26, "90th_percentile": 2214.26, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2344.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2344.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2344.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2467.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Capsl ctrc rmvl insj 1+", "code_information": [ { "code": "66991", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15646.67, "discounted_cash": 15646.67, "minimum": 5303.14, "maximum": 5582.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5303.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5303.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5303.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Capsl ctrc rmvl insj 1+", "code_information": [ { "code": "66991", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15646.67, "discounted_cash": 15646.67, "minimum": 5303.14, "maximum": 5582.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "modifiers": "LT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 5582.25, "count": "1 through 10", "median_amount": 2399.48, "10th_percentile": 2399.48, "90th_percentile": 2399.48, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5303.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5303.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5303.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Capsl ctrc rmvl insj 1+", "code_information": [ { "code": "66991", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 15531.33, "discounted_cash": 15531.33, "minimum": 5303.14, "maximum": 5582.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "modifiers": "RT", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5303.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5303.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5303.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 5582.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "67700 drain abscess-eyelid ed tech fee", "code_information": [ { "code": "67700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 931.00, "discounted_cash": 931.00, "minimum": 307.24, "maximum": 323.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drainage of eyelid abscess", "code_information": [ { "code": "67700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 931.00, "discounted_cash": 931.00, "minimum": 307.24, "maximum": 323.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "67938 removal embedded foreign body eyelid techfee", "code_information": [ { "code": "67938", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 931.00, "discounted_cash": 931.00, "minimum": 307.24, "maximum": 323.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove eyelid foreign body", "code_information": [ { "code": "67938", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 931.00, "discounted_cash": 931.00, "minimum": 307.24, "maximum": 323.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 307.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 323.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "69000 drain extern.ear les ed tech fee", "code_information": [ { "code": "69000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain external ear lesion", "code_information": [ { "code": "69000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "69020 er- drainage ext auditory canal abscess techfee", "code_information": [ { "code": "69020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drain outer ear canal lesion", "code_information": [ { "code": "69020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2100.00, "discounted_cash": 2100.00, "minimum": 723.15, "maximum": 761.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 723.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 761.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "69200 remove fb ear canal w/o a techfee", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clear outer ear canal", "code_information": [ { "code": "69200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "69209 removal cerumen w/irrigat techfee", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove impacted ear wax uni", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "69210 remove impacted cerumen techfee", "code_information": [ { "code": "69210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 139.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "1 through 10", "median_amount": 55.10, "10th_percentile": 28.22, "90th_percentile": 81.99, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Remove impacted ear wax uni", "code_information": [ { "code": "69210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 139.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "1 through 10", "median_amount": 55.10, "10th_percentile": 28.22, "90th_percentile": 81.99, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "69436 tympanostomy (requir insertion of vent tube) gen anes", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 493.00, "discounted_cash": 493.00, "minimum": 1522.46, "maximum": 1602.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Create eardrum opening", "code_information": [ { "code": "69436", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 493.00, "discounted_cash": 493.00, "minimum": 1522.46, "maximum": 1602.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1522.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1602.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of jaw <4views", "code_information": [ { "code": "70100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr mandible less than 4 views", "code_information": [ { "code": "70100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of jaw 4/> views", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 386.00, "discounted_cash": 386.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr mandible complete 4+ views", "code_information": [ { "code": "70110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 386.00, "discounted_cash": 386.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of facial bones", "code_information": [ { "code": "70140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr facial bones < 3 views", "code_information": [ { "code": "70140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of facial bones", "code_information": [ { "code": "70150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr facial bones 3+ views", "code_information": [ { "code": "70150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of nasal bones", "code_information": [ { "code": "70160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr nasal bones 3+ views", "code_information": [ { "code": "70160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of eye sockets", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr orbits complete", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of sinuses", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sinuses paranasal < 3 views", "code_information": [ { "code": "70210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of sinuses", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sinuses paranasal complete", "code_information": [ { "code": "70220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of skull", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr skull < 4 views", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of skull", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr skull complete", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnetic image jaw joint", "code_information": [ { "code": "70336", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2929.00, "discounted_cash": 2929.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri tmj", "code_information": [ { "code": "70336", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2929.00, "discounted_cash": 2929.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of neck", "code_information": [ { "code": "70360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 277.00, "discounted_cash": 277.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 123.90, "10th_percentile": 123.90, "90th_percentile": 123.90, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr neck soft tissue", "code_information": [ { "code": "70360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 277.00, "discounted_cash": 277.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 123.90, "10th_percentile": 123.90, "90th_percentile": 123.90, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct brain/head w/o contrast", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2099.00, "discounted_cash": 2099.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct head/brain w/o dye", "code_information": [ { "code": "70450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2099.00, "discounted_cash": 2099.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct brain/head w/ contrast", "code_information": [ { "code": "70460", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct head/brain w/dye", "code_information": [ { "code": "70460", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct brain/head w/ + w/o contrast", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2260.00, "discounted_cash": 2260.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 967.55, "10th_percentile": 967.55, "90th_percentile": 967.55, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct head/brain w/o & w/dye", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2260.00, "discounted_cash": 2260.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 967.55, "10th_percentile": 967.55, "90th_percentile": 967.55, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct orbit/ear/fossa w/o dye", "code_information": [ { "code": "70480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1115.00, "discounted_cash": 1115.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct orbits sella w/o contrast", "code_information": [ { "code": "70480", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1115.00, "discounted_cash": 1115.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct orbit/ear/fossa w/dye", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1140.00, "discounted_cash": 1140.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct orbits sella w/ contrast", "code_information": [ { "code": "70481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1140.00, "discounted_cash": 1140.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct orbit/ear/fossa w/o&w/dye", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1285.00, "discounted_cash": 1285.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct orbits sella w/ + w/o contrast", "code_information": [ { "code": "70482", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1285.00, "discounted_cash": 1285.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillofacial w/o contrast", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 902.78, "10th_percentile": 902.78, "90th_percentile": 902.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillofacial w/o dye", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 902.78, "10th_percentile": 902.78, "90th_percentile": 902.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillofacial w/ contrast", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1537.00, "discounted_cash": 1537.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillofacial w/dye", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1537.00, "discounted_cash": 1537.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillofacial w/ + w/o contrast", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1537.00, "discounted_cash": 1537.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct maxillofacial w/o & w/dye", "code_information": [ { "code": "70488", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1537.00, "discounted_cash": 1537.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct neck soft tissue w/o contrast", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1537.00, "discounted_cash": 1537.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 687.22, "10th_percentile": 687.22, "90th_percentile": 687.22, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct soft tissue neck w/o dye", "code_information": [ { "code": "70490", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1537.00, "discounted_cash": 1537.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 687.22, "10th_percentile": 687.22, "90th_percentile": 687.22, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct neck soft tissue w/ contrast", "code_information": [ { "code": "70491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 864.50, "10th_percentile": 823.68, "90th_percentile": 905.32, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct soft tissue neck w/dye", "code_information": [ { "code": "70491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 864.50, "10th_percentile": 823.68, "90th_percentile": 905.32, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct neck soft tissue w/ + w/o contrast", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1537.00, "discounted_cash": 1537.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct sft tsue nck w/o & w/dye", "code_information": [ { "code": "70492", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1537.00, "discounted_cash": 1537.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio brain/head", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1323.06, "10th_percentile": 1242.19, "90th_percentile": 1351.28, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "11", "median_amount": 915.52, "10th_percentile": 889.06, "90th_percentile": 956.21, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1037.21, "10th_percentile": 1037.21, "90th_percentile": 1037.21, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angiography head", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1323.06, "10th_percentile": 1242.19, "90th_percentile": 1351.28, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "11", "median_amount": 915.52, "10th_percentile": 889.06, "90th_percentile": 956.21, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1037.21, "10th_percentile": 1037.21, "90th_percentile": 1037.21, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio neck", "code_information": [ { "code": "70498", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1343.40, "10th_percentile": 1327.12, "90th_percentile": 1359.69, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 915.96, "10th_percentile": 915.96, "90th_percentile": 915.96, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angiography neck", "code_information": [ { "code": "70498", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1343.40, "10th_percentile": 1327.12, "90th_percentile": 1359.69, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 915.96, "10th_percentile": 915.96, "90th_percentile": 915.96, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri face neck orbit w/o contrast", "code_information": [ { "code": "70540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2251.00, "discounted_cash": 2251.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri orbit/face/neck w/o dye", "code_information": [ { "code": "70540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2251.00, "discounted_cash": 2251.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri face neck orbit w/ + w/o contrast", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3102.00, "discounted_cash": 3102.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri orbt/fac/nck w/o &w/dye", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3102.00, "discounted_cash": 3102.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiography head w/o dye", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3164.00, "discounted_cash": 3164.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra brain/head w/o contrast", "code_information": [ { "code": "70544", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3164.00, "discounted_cash": 3164.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiography head w/dye", "code_information": [ { "code": "70545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3368.00, "discounted_cash": 3368.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra brain/head w/ contrast", "code_information": [ { "code": "70545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3368.00, "discounted_cash": 3368.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiograph head w/o&w/dye", "code_information": [ { "code": "70546", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 3796.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra brain/head w/ + w/o contrast", "code_information": [ { "code": "70546", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 3796.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiography neck w/o dye", "code_information": [ { "code": "70547", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra neck w/o contrast", "code_information": [ { "code": "70547", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiography neck w/dye", "code_information": [ { "code": "70548", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3164.00, "discounted_cash": 3164.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra neck w/ contrast", "code_information": [ { "code": "70548", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3164.00, "discounted_cash": 3164.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angiograph neck w/o&w/dye", "code_information": [ { "code": "70549", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 3796.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra neck w/ + w/o contrast", "code_information": [ { "code": "70549", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 3796.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri brain stem w/o dye", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3603.00, "discounted_cash": 3603.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 2169.73, "10th_percentile": 2169.73, "90th_percentile": 2169.73, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1611.18, "10th_percentile": 1611.18, "90th_percentile": 1611.18, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri brain w/o contrast", "code_information": [ { "code": "70551", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3603.00, "discounted_cash": 3603.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 2169.73, "10th_percentile": 2169.73, "90th_percentile": 2169.73, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1611.18, "10th_percentile": 1611.18, "90th_percentile": 1611.18, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri brain stem w/o & w/dye", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4043.00, "discounted_cash": 4043.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1314.35, "10th_percentile": 1314.35, "90th_percentile": 1314.35, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1807.85, "10th_percentile": 1807.85, "90th_percentile": 1807.85, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri brain w/ + w/o contrast", "code_information": [ { "code": "70553", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4043.00, "discounted_cash": 4043.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1314.35, "10th_percentile": 1314.35, "90th_percentile": 1314.35, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1807.85, "10th_percentile": 1807.85, "90th_percentile": 1807.85, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam chest 1 view", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 299.00, "discounted_cash": 299.00, "minimum": 866.03, "maximum": 911.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr chest 1 view frontal", "code_information": [ { "code": "71045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 299.00, "discounted_cash": 299.00, "minimum": 866.03, "maximum": 911.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam chest 2 views", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 308.00, "minimum": 866.03, "maximum": 911.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 911.61, "count": "1 through 10", "median_amount": 3.78, "10th_percentile": 3.78, "90th_percentile": 81.59, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 911.61, "count": "1 through 10", "median_amount": 123.80, "10th_percentile": 34.88, "90th_percentile": 127.74, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 911.61, "count": "35", "median_amount": 137.72, "10th_percentile": 122.43, "90th_percentile": 141.86, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "1 through 10", "median_amount": 3.78, "10th_percentile": 3.78, "90th_percentile": 177.20, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr chest 2 views", "code_information": [ { "code": "71046", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 308.00, "minimum": 866.03, "maximum": 911.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 911.61, "count": "1 through 10", "median_amount": 3.78, "10th_percentile": 3.78, "90th_percentile": 81.59, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 911.61, "count": "1 through 10", "median_amount": 123.80, "10th_percentile": 34.88, "90th_percentile": 127.74, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 911.61, "count": "35", "median_amount": 137.72, "10th_percentile": 122.43, "90th_percentile": 141.86, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "1 through 10", "median_amount": 3.78, "10th_percentile": 3.78, "90th_percentile": 177.20, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam chest 3 views", "code_information": [ { "code": "71047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 370.00, "discounted_cash": 370.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr chest 3 views", "code_information": [ { "code": "71047", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 370.00, "discounted_cash": 370.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam ribs uni 2 views", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs 2 views left", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam unilat ribs/chest", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs 3+ views left w/ pa chest", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam ribs bil 3 views", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 419.00, "discounted_cash": 419.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ribs 3 views bilateral", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 419.00, "discounted_cash": 419.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam breastbone 2/>vws", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.00, "discounted_cash": 243.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sternum 2+ views", "code_information": [ { "code": "71120", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.00, "discounted_cash": 243.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "71250 - ct chest w/o contrast", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2099.00, "discounted_cash": 2099.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 903.73, "10th_percentile": 803.73, "90th_percentile": 1003.73, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 971.56, "10th_percentile": 698.77, "90th_percentile": 1244.34, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "12", "median_amount": 907.38, "10th_percentile": 894.02, "90th_percentile": 966.80, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct thorax w/o dye", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2099.00, "discounted_cash": 2099.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 903.73, "10th_percentile": 803.73, "90th_percentile": 1003.73, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 971.56, "10th_percentile": 698.77, "90th_percentile": 1244.34, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "12", "median_amount": 907.38, "10th_percentile": 894.02, "90th_percentile": 966.80, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct chest w/ contrast", "code_information": [ { "code": "71260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2408.00, "discounted_cash": 2408.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1076.88, "10th_percentile": 1048.07, "90th_percentile": 1631.44, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1239.14, "10th_percentile": 1239.14, "90th_percentile": 1239.14, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct thorax w/dye", "code_information": [ { "code": "71260", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2408.00, "discounted_cash": 2408.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1076.88, "10th_percentile": 1048.07, "90th_percentile": 1631.44, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1239.14, "10th_percentile": 1239.14, "90th_percentile": 1239.14, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "71270 - ct chest w/ + w/o contrast", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1507.00, "discounted_cash": 1507.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 673.86, "10th_percentile": 673.86, "90th_percentile": 673.86, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct thorax w/o & w/dye", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1507.00, "discounted_cash": 1507.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 673.86, "10th_percentile": 673.86, "90th_percentile": 673.86, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lung cancer screening", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 397.00, "discounted_cash": 397.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 252.79, "10th_percentile": 252.79, "90th_percentile": 252.79, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 252.79, "10th_percentile": 252.79, "90th_percentile": 260.67, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 238.20, "10th_percentile": 215.97, "90th_percentile": 260.43, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct thorax lung cancer scr c-", "code_information": [ { "code": "71271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 397.00, "discounted_cash": 397.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 252.79, "10th_percentile": 252.79, "90th_percentile": 252.79, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 252.79, "10th_percentile": 252.79, "90th_percentile": 260.67, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 238.20, "10th_percentile": 215.97, "90th_percentile": 260.43, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio chest", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2466.00, "discounted_cash": 2466.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "18", "median_amount": 1102.68, "10th_percentile": 1055.75, "90th_percentile": 1135.84, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1268.82, "10th_percentile": 1268.82, "90th_percentile": 1268.82, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angiography chest", "code_information": [ { "code": "71275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2466.00, "discounted_cash": 2466.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "18", "median_amount": 1102.68, "10th_percentile": 1055.75, "90th_percentile": 1135.84, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1268.82, "10th_percentile": 1268.82, "90th_percentile": 1268.82, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest w/o contrast", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2251.00, "discounted_cash": 2251.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest w/o dye", "code_information": [ { "code": "71550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2251.00, "discounted_cash": 2251.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest w/ + w/o contrast", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 3796.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest w/o & w/dye", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 3796.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra chest w/ + w/o contrast", "code_information": [ { "code": "71555", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3164.00, "discounted_cash": 3164.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri angio chest w or w/o dye", "code_information": [ { "code": "71555", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3164.00, "discounted_cash": 3164.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam neck spine 2-3 vw", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 184.54, "10th_percentile": 184.54, "90th_percentile": 184.54, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 175.95, "10th_percentile": 175.95, "90th_percentile": 176.96, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 39.27, "10th_percentile": 39.27, "90th_percentile": 39.27, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr spine cervical 2 or 3 views", "code_information": [ { "code": "72040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 184.54, "10th_percentile": 184.54, "90th_percentile": 184.54, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 175.95, "10th_percentile": 175.95, "90th_percentile": 176.96, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 39.27, "10th_percentile": 39.27, "90th_percentile": 39.27, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam neck spine 4/5vws", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 426.00, "discounted_cash": 426.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 196.22, "10th_percentile": 196.22, "90th_percentile": 196.22, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr spine cervical 4 or 5 views", "code_information": [ { "code": "72050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 426.00, "discounted_cash": 426.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 196.22, "10th_percentile": 196.22, "90th_percentile": 196.22, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam thorac spine 2vws", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 445.00, "discounted_cash": 445.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 8.12, "10th_percentile": 8.12, "90th_percentile": 8.12, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 283.65, "10th_percentile": 283.65, "90th_percentile": 283.65, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 198.98, "10th_percentile": 198.98, "90th_percentile": 203.77, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 27.73, "10th_percentile": 27.73, "90th_percentile": 27.73, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 17.92, "10th_percentile": 3.23, "90th_percentile": 165.38, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr spine thoracic 2 views", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 445.00, "discounted_cash": 445.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 8.12, "10th_percentile": 8.12, "90th_percentile": 8.12, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 283.65, "10th_percentile": 283.65, "90th_percentile": 283.65, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 198.98, "10th_percentile": 198.98, "90th_percentile": 203.77, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 27.73, "10th_percentile": 27.73, "90th_percentile": 27.73, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 17.92, "10th_percentile": 3.23, "90th_percentile": 165.38, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam thorac spine 3vws", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr spine thoracic 3 views", "code_information": [ { "code": "72072", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam entire spi 1 vw", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 335.00, "discounted_cash": 335.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr spine scoliosis 1 view", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 335.00, "discounted_cash": 335.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam entire spi 2/3 vw", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 446.00, "discounted_cash": 446.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr spine scoliosis 2-3 views", "code_information": [ { "code": "72082", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 446.00, "discounted_cash": 446.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam l-s spine 2/3 vws", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 450.00, "discounted_cash": 450.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 14.77, "10th_percentile": 8.88, "90th_percentile": 129.87, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 213.43, "10th_percentile": 213.43, "90th_percentile": 213.43, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "29", "median_amount": 201.28, "10th_percentile": 90.07, "90th_percentile": 207.27, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 39.27, "10th_percentile": 39.27, "90th_percentile": 249.05, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr spine lumbosacral 2 or 3 views", "code_information": [ { "code": "72100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 450.00, "discounted_cash": 450.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 14.77, "10th_percentile": 8.88, "90th_percentile": 129.87, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 213.43, "10th_percentile": 213.43, "90th_percentile": 213.43, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "29", "median_amount": 201.28, "10th_percentile": 90.07, "90th_percentile": 207.27, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 39.27, "10th_percentile": 39.27, "90th_percentile": 249.05, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam l-2 spine 4/>vws", "code_information": [ { "code": "72110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 595.00, "discounted_cash": 595.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 266.23, "10th_percentile": 255.96, "90th_percentile": 272.49, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr spine lumbosacral 4+ views", "code_information": [ { "code": "72110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 595.00, "discounted_cash": 595.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 266.23, "10th_percentile": 255.96, "90th_percentile": 272.49, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct neck spine w/o dye", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2204.00, "discounted_cash": 2204.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 1251.15, "10th_percentile": 1251.15, "90th_percentile": 1251.15, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "13", "median_amount": 985.68, "10th_percentile": 985.68, "90th_percentile": 1015.16, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct spine cervical w/o contrast", "code_information": [ { "code": "72125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2204.00, "discounted_cash": 2204.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 1251.15, "10th_percentile": 1251.15, "90th_percentile": 1251.15, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "13", "median_amount": 985.68, "10th_percentile": 985.68, "90th_percentile": 1015.16, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct chest spine w/o dye", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 902.78, "10th_percentile": 902.78, "90th_percentile": 902.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct spine thoracic w/o contrast", "code_information": [ { "code": "72128", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 902.78, "10th_percentile": 902.78, "90th_percentile": 902.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lumbar spine w/o dye", "code_information": [ { "code": "72131", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 1129.68, "10th_percentile": 1129.68, "90th_percentile": 1129.68, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 924.94, "10th_percentile": 902.78, "90th_percentile": 929.95, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct spine lumbar w/o contrast", "code_information": [ { "code": "72131", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 1129.68, "10th_percentile": 1129.68, "90th_percentile": 1129.68, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 924.94, "10th_percentile": 902.78, "90th_percentile": 929.95, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri neck spine w/o dye", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3603.00, "discounted_cash": 3603.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1703.94, "10th_percentile": 1703.94, "90th_percentile": 1703.94, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1182.86, "10th_percentile": 1182.86, "90th_percentile": 1182.86, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1611.18, "10th_percentile": 1611.18, "90th_percentile": 1649.87, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri spine cervical w/o contrast", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3603.00, "discounted_cash": 3603.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1703.94, "10th_percentile": 1703.94, "90th_percentile": 1703.94, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1182.86, "10th_percentile": 1182.86, "90th_percentile": 1182.86, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1611.18, "10th_percentile": 1611.18, "90th_percentile": 1649.87, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest spine w/o dye", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2544.00, "discounted_cash": 2544.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1137.68, "10th_percentile": 1137.68, "90th_percentile": 1137.68, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri spine thoracic w/o contrast", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2544.00, "discounted_cash": 2544.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1137.68, "10th_percentile": 1137.68, "90th_percentile": 1137.68, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lumbar spine w/o dye", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2812.00, "discounted_cash": 2812.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1446.90, "10th_percentile": 1446.90, "90th_percentile": 1446.90, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 592.98, "10th_percentile": 592.98, "90th_percentile": 592.98, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1295.21, "10th_percentile": 1257.44, "90th_percentile": 1295.21, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri spine lumbar w/o contrast", "code_information": [ { "code": "72148", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2812.00, "discounted_cash": 2812.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1446.90, "10th_percentile": 1446.90, "90th_percentile": 1446.90, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 592.98, "10th_percentile": 592.98, "90th_percentile": 592.98, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 1295.21, "10th_percentile": 1257.44, "90th_percentile": 1295.21, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri neck spine w/o & w/dye", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3224.00, "discounted_cash": 3224.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1859.16, "10th_percentile": 1859.16, "90th_percentile": 1859.16, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1488.90, "10th_percentile": 1488.90, "90th_percentile": 1488.90, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri spine cervical w/ + w/o contrast", "code_information": [ { "code": "72156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3224.00, "discounted_cash": 3224.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1859.16, "10th_percentile": 1859.16, "90th_percentile": 1859.16, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1488.90, "10th_percentile": 1488.90, "90th_percentile": 1488.90, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri chest spine w/o & w/dye", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri spine thoracic w/ + w/o contrast", "code_information": [ { "code": "72157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lumbar spine w/o & w/dye", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1811.51, "10th_percentile": 1811.51, "90th_percentile": 1811.51, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri spine lumbar w/ + w/o contrast", "code_information": [ { "code": "72158", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1811.51, "10th_percentile": 1811.51, "90th_percentile": 1811.51, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angio spine w/o&w/dye", "code_information": [ { "code": "72159", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3164.00, "discounted_cash": 3164.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra spinal contents w/ + w/o contrast", "code_information": [ { "code": "72159", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3164.00, "discounted_cash": 3164.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of pelvis", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 386.00, "discounted_cash": 386.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 172.72, "10th_percentile": 167.58, "90th_percentile": 172.72, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr pelvis 1 or 2 views", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 386.00, "discounted_cash": 386.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 172.72, "10th_percentile": 167.58, "90th_percentile": 172.72, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of pelvis", "code_information": [ { "code": "72190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr pelvis complete 3+ views", "code_information": [ { "code": "72190", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w/o contrast", "code_information": [ { "code": "72192", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 902.78, "10th_percentile": 864.36, "90th_percentile": 929.95, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w/o dye", "code_information": [ { "code": "72192", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 902.78, "10th_percentile": 864.36, "90th_percentile": 929.95, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w/ contrast", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w/dye", "code_information": [ { "code": "72193", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w/ + w/o contrast", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct pelvis w/o & w/dye", "code_information": [ { "code": "72194", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri pelvis w/o contrast", "code_information": [ { "code": "72195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3224.00, "discounted_cash": 3224.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri pelvis w/o dye", "code_information": [ { "code": "72195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3224.00, "discounted_cash": 3224.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri pelvis w/ + w/o contrast", "code_information": [ { "code": "72197", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1054.85, "10th_percentile": 1054.85, "90th_percentile": 1054.85, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri pelvis w/o & w/dye", "code_information": [ { "code": "72197", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1054.85, "10th_percentile": 1054.85, "90th_percentile": 1054.85, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angio pelvis w/o & w/dye", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 3796.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra pelvis w/ + w/o contrast", "code_information": [ { "code": "72198", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 3796.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam si joints 3/> vws", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 181.02, "10th_percentile": 181.02, "90th_percentile": 181.02, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sacroiliac joints 3+ views", "code_information": [ { "code": "72202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 181.02, "10th_percentile": 181.02, "90th_percentile": 181.02, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam sacrum tailbone", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr sacrum/coccyx 2+ views", "code_information": [ { "code": "72220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of collar bone", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr clavicle left", "code_information": [ { "code": "73000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of shoulder blade", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr scapula left", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of shoulder", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr shoulder 1 view left", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of shoulder", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 341.00, "discounted_cash": 341.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr shoulder complete 2+ views left", "code_information": [ { "code": "73030", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 341.00, "discounted_cash": 341.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of shoulders", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.00, "discounted_cash": 243.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ac joints bilateral", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.00, "discounted_cash": 243.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of humerus", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr humerus left", "code_information": [ { "code": "73060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of elbow", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr elbow 2 views left", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of elbow", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 297.00, "discounted_cash": 297.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr elbow complete 3+ views left", "code_information": [ { "code": "73080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 297.00, "discounted_cash": 297.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of forearm", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 260.00, "discounted_cash": 260.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr forearm 2 views left", "code_information": [ { "code": "73090", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 260.00, "discounted_cash": 260.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of wrist", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr wrist 2 views left", "code_information": [ { "code": "73100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of wrist", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 341.00, "discounted_cash": 341.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr wrist complete 3+ views left", "code_information": [ { "code": "73110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 341.00, "discounted_cash": 341.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of hand", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 310.00, "discounted_cash": 310.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hand complete 3+ views left", "code_information": [ { "code": "73130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 310.00, "discounted_cash": 310.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of finger(s)", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr finger(s) 2+ views left", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper extremity w/o contrast bilat", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4038.00, "discounted_cash": 4038.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper extremity w/o dye", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4038.00, "discounted_cash": 4038.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper extremity w/ contrast bilat", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2631.00, "discounted_cash": 2631.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper extremity w/dye", "code_information": [ { "code": "73201", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2631.00, "discounted_cash": 2631.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct upper extremity w/+w/o contrast bilat", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2506.00, "discounted_cash": 2506.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct uppr extremity w/o&w/dye", "code_information": [ { "code": "73202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2506.00, "discounted_cash": 2506.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri upper extremity w/o contrast left", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3464.00, "discounted_cash": 3464.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri upper extremity w/o dye", "code_information": [ { "code": "73218", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3464.00, "discounted_cash": 3464.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri ue joint w/ + w/o contrast right", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri uppr extremity w/o&w/dye", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri joint upr extrem w/o dye", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3586.00, "discounted_cash": 3586.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri ue joint w/o contrast left", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3586.00, "discounted_cash": 3586.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri joint upr extrem w/dye", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2358.00, "discounted_cash": 2358.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri shoulder w/ contrast left", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2358.00, "discounted_cash": 2358.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri joint upr extr w/o&w/dye", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3102.00, "discounted_cash": 3102.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri ue joint w/ + w/o contrast left", "code_information": [ { "code": "73223", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3102.00, "discounted_cash": 3102.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr angio upr extr w/o&w/dye", "code_information": [ { "code": "73225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 3796.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra upper extremity w/ + w/o cnt left", "code_information": [ { "code": "73225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3796.00, "discounted_cash": 3796.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam hip uni 1 view", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hip 1 view w/ ap pelvis left", "code_information": [ { "code": "73501", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam hip uni 2-3 views", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 457.00, "discounted_cash": 457.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hip 2-3 views w/ap pelvis left", "code_information": [ { "code": "73502", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 457.00, "discounted_cash": 457.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam hips bi 5/> views", "code_information": [ { "code": "73523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.00, "discounted_cash": 334.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr hip 1 view bilateral", "code_information": [ { "code": "73523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 334.00, "discounted_cash": 334.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of femur 2/>", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 297.00, "discounted_cash": 297.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr femur 2 views left", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 297.00, "discounted_cash": 297.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of knee 1 or 2", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 344.00, "discounted_cash": 344.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee 1 or 2 views left", "code_information": [ { "code": "73560", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 344.00, "discounted_cash": 344.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of knee 3", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 357.00, "discounted_cash": 357.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee 3 views left", "code_information": [ { "code": "73562", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 357.00, "discounted_cash": 357.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam knee 4 or more", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee complete 4+ views left", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of knees", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 785.00, "discounted_cash": 785.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr knee 1 view standing ap bilateral", "code_information": [ { "code": "73565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 785.00, "discounted_cash": 785.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of lower leg", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 320.00, "discounted_cash": 320.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr tibia/fibula left", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 320.00, "discounted_cash": 320.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of ankle", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ankle 2 views left", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of ankle", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 351.00, "discounted_cash": 351.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ankle complete 3+ views left", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 351.00, "discounted_cash": 351.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of foot", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr foot 2 views right", "code_information": [ { "code": "73620", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of foot", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 430.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr foot complete 3+ views left", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 430.00, "discounted_cash": 430.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of heel", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr calcaneus left", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam of toe(s)", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr toe(s) 2+ views left", "code_information": [ { "code": "73660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 275.00, "discounted_cash": 275.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower extremity w/o contrast left", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower extremity w/o dye", "code_information": [ { "code": "73700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower extremity w/ contrast bilat", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2506.00, "discounted_cash": 2506.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower extremity w/dye", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2506.00, "discounted_cash": 2506.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lower extremity w/+w/o contrast bilat", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2506.00, "discounted_cash": 2506.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct lwr extremity w/o&w/dye", "code_information": [ { "code": "73702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2506.00, "discounted_cash": 2506.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lower extremity w/o contrast left", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3464.00, "discounted_cash": 3464.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lower extremity w/o dye", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3464.00, "discounted_cash": 3464.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lower extremity w/ + w/o cnt left", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3464.00, "discounted_cash": 3464.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri lwr extremity w/o&w/dye", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3464.00, "discounted_cash": 3464.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri jnt of lwr extre w/o dye", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3265.00, "discounted_cash": 3265.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri le joint w/o contrast left", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3265.00, "discounted_cash": 3265.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri joint of lwr extr w/dye", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.00, "discounted_cash": 3003.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri le joint w/ contrast left", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3003.00, "discounted_cash": 3003.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri joint lwr extr w/o&w/dye", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri le joint w/ + w/o contrast left", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3344.00, "discounted_cash": 3344.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam abdomen 1 view", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 236.00, "discounted_cash": 236.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 105.48, "10th_percentile": 105.48, "90th_percentile": 107.09, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 139.75, "10th_percentile": 125.05, "90th_percentile": 154.44, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr abdomen 1 view", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 236.00, "discounted_cash": 236.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 105.48, "10th_percentile": 105.48, "90th_percentile": 107.09, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "1 through 10", "median_amount": 139.75, "10th_percentile": 125.05, "90th_percentile": 154.44, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam abdomen 2 views", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 356.00, "discounted_cash": 356.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 124.75, "10th_percentile": 124.75, "90th_percentile": 124.75, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 183.38, "10th_percentile": 183.38, "90th_percentile": 183.38, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr abdomen 2 views", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 356.00, "discounted_cash": 356.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 124.75, "10th_percentile": 124.75, "90th_percentile": 124.75, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 183.38, "10th_percentile": 183.38, "90th_percentile": 183.38, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam abdomen 3+ views", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 399.00, "discounted_cash": 399.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr abdomen 3+ views", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 399.00, "discounted_cash": 399.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray exam complete abdomen", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 480.00, "discounted_cash": 480.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr abdomen series + chest 1 view", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 480.00, "discounted_cash": 480.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen w/o contrast", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen w/o dye", "code_information": [ { "code": "74150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen w/ contrast", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 850.28, "10th_percentile": 850.28, "90th_percentile": 850.28, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen w/dye", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 850.28, "10th_percentile": 850.28, "90th_percentile": 850.28, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen w/ + w/o contrast", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2260.00, "discounted_cash": 2260.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen w/o & w/dye", "code_information": [ { "code": "74170", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2260.00, "discounted_cash": 2260.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio abdom w/o & w/dye", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 956.21, "10th_percentile": 808.18, "90th_percentile": 956.21, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1100.28, "10th_percentile": 1100.28, "90th_percentile": 1100.28, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio abdomen", "code_information": [ { "code": "74175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2138.00, "discounted_cash": 2138.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 956.21, "10th_percentile": 808.18, "90th_percentile": 956.21, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1100.28, "10th_percentile": 1100.28, "90th_percentile": 1100.28, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abd & pelvis w/o contrast", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2224.00, "discounted_cash": 2224.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 1417.60, "10th_percentile": 1417.60, "90th_percentile": 1417.60, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 985.00, "10th_percentile": 975.55, "90th_percentile": 994.44, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen and pelvis w/o contrast", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2224.00, "discounted_cash": 2224.00, "minimum": 230.79, "maximum": 242.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 1417.60, "10th_percentile": 1417.60, "90th_percentile": 1417.60, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 242.94, "count": "1 through 10", "median_amount": 985.00, "10th_percentile": 975.55, "90th_percentile": 994.44, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 230.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 242.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "74177 - ct abdomen and pelvis w/ contrast", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2370.00, "discounted_cash": 2370.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1438.61, "10th_percentile": 1438.61, "90th_percentile": 1473.28, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "22", "median_amount": 1009.17, "10th_percentile": 970.52, "90th_percentile": 1039.57, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1161.23, "10th_percentile": 1161.23, "90th_percentile": 1161.23, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abd & pelv w/contrast", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2370.00, "discounted_cash": 2370.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1438.61, "10th_percentile": 1438.61, "90th_percentile": 1473.28, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "22", "median_amount": 1009.17, "10th_percentile": 970.52, "90th_percentile": 1039.57, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 1161.23, "10th_percentile": 1161.23, "90th_percentile": 1161.23, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abd & pelv 1/> regns", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 902.78, "10th_percentile": 868.51, "90th_percentile": 902.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct abdomen and pelvis w/ + w/o contrast", "code_information": [ { "code": "74178", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 447.22, "maximum": 470.75, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 470.75, "count": "1 through 10", "median_amount": 902.78, "10th_percentile": 868.51, "90th_percentile": 902.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 447.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 470.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri abdomen w/o contrast", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2251.00, "discounted_cash": 2251.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 709.84, "10th_percentile": 709.84, "90th_percentile": 709.84, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri abdomen w/o dye", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2251.00, "discounted_cash": 2251.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "1 through 10", "median_amount": 709.84, "10th_percentile": 709.84, "90th_percentile": 709.84, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri abdomen w/ contrast", "code_information": [ { "code": "74182", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2544.00, "discounted_cash": 2544.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri abdomen w/dye", "code_information": [ { "code": "74182", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2544.00, "discounted_cash": 2544.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri abdomen w/ + w/o contrast", "code_information": [ { "code": "74183", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2911.00, "discounted_cash": 2911.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1255.66, "10th_percentile": 1218.86, "90th_percentile": 1292.46, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1497.78, "10th_percentile": 1497.78, "90th_percentile": 1497.78, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri abdomen w/o & w/dye", "code_information": [ { "code": "74183", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2911.00, "discounted_cash": 2911.00, "minimum": 878.59, "maximum": 924.83, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1255.66, "10th_percentile": 1218.86, "90th_percentile": 1292.46, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 878.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 924.83, "count": "1 through 10", "median_amount": 1497.78, "10th_percentile": 1497.78, "90th_percentile": 1497.78, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 924.83, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra abdomen w/ + w/o contrast", "code_information": [ { "code": "74185", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2911.00, "discounted_cash": 2911.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mri angio abdom w orw/o dye", "code_information": [ { "code": "74185", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2911.00, "discounted_cash": 2911.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray xm esophagus 1cntrst", "code_information": [ { "code": "74220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 865.00, "discounted_cash": 865.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr esophagus", "code_information": [ { "code": "74220", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 865.00, "discounted_cash": 865.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray xm swlng funcj c+", "code_information": [ { "code": "74230", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 511.00, "discounted_cash": 511.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr swallowing function w/ speech", "code_information": [ { "code": "74230", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 511.00, "discounted_cash": 511.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray xm upr gi trc 1cntrst", "code_information": [ { "code": "74240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 795.00, "discounted_cash": 795.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr upper gi w/ small bowel", "code_information": [ { "code": "74240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 795.00, "discounted_cash": 795.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray xm upr gi trc 2cntrst", "code_information": [ { "code": "74246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 865.00, "discounted_cash": 865.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr upper gi w/ air contrast", "code_information": [ { "code": "74246", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 865.00, "discounted_cash": 865.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray xm sm int 1cntrst std", "code_information": [ { "code": "74250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 511.00, "discounted_cash": 511.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr small bowel w/ multiple series", "code_information": [ { "code": "74250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 511.00, "discounted_cash": 511.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray xm colon 1cntrst std", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 865.00, "discounted_cash": 865.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr barium enema complete", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 865.00, "discounted_cash": 865.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray xm colon 2cntrst std", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 824.00, "discounted_cash": 824.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr barium enema w/ air complete", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 824.00, "discounted_cash": 824.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray guide for gi tube", "code_information": [ { "code": "74340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 134.00, "discounted_cash": 134.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr insertion long gi tube w/ fluoro", "code_information": [ { "code": "74340", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 134.00, "discounted_cash": 134.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Contrst x-ray urinary tract", "code_information": [ { "code": "74410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 865.00, "discounted_cash": 865.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr ivp", "code_information": [ { "code": "74410", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 865.00, "discounted_cash": 865.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Contrast x-ray bladder", "code_information": [ { "code": "74430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1078.00, "discounted_cash": 1078.00, "minimum": 367.06, "maximum": 386.38, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 367.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 367.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 367.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr cystogram", "code_information": [ { "code": "74430", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1078.00, "discounted_cash": 1078.00, "minimum": 367.06, "maximum": 386.38, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 367.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 367.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 367.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 386.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-ray urethra/bladder", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 802.00, "discounted_cash": 802.00, "minimum": 248.44, "maximum": 261.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr voiding urethrocystography", "code_information": [ { "code": "74455", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 802.00, "discounted_cash": 802.00, "minimum": 248.44, "maximum": 261.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio abdominal aorta with runoff", "code_information": [ { "code": "75635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2380.00, "discounted_cash": 2380.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ct angio abdominal arteries", "code_information": [ { "code": "75635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2380.00, "discounted_cash": 2380.00, "minimum": 182.97, "maximum": 192.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 182.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 192.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluoroscopy <1 hr phys/qhp", "code_information": [ { "code": "76000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 802.00, "discounted_cash": 802.00, "minimum": 248.44, "maximum": 261.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr fluoroscopy in imaging per hour eo", "code_information": [ { "code": "76000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 802.00, "discounted_cash": 802.00, "minimum": 248.44, "maximum": 261.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "76512 - ocular us fac ed pocus techfee", "code_information": [ { "code": "76512", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ophth us b w/non-quant a", "code_information": [ { "code": "76512", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 376.00, "discounted_cash": 376.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam of head and neck", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 637.00, "discounted_cash": 637.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 206.95, "10th_percentile": 206.95, "90th_percentile": 206.95, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 284.65, "10th_percentile": 279.43, "90th_percentile": 290.77, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us head/neck soft tissue", "code_information": [ { "code": "76536", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 637.00, "discounted_cash": 637.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 206.95, "10th_percentile": 206.95, "90th_percentile": 206.95, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 284.65, "10th_percentile": 279.43, "90th_percentile": 290.77, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ultrasound breast complete", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 345.00, "discounted_cash": 345.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us axilla left", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 345.00, "discounted_cash": 345.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us abdomen complete", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 785.00, "discounted_cash": 785.00, "minimum": 315.02, "maximum": 331.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam abdom complete", "code_information": [ { "code": "76700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 785.00, "discounted_cash": 785.00, "minimum": 315.02, "maximum": 331.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "76705 - abd limited us fac ed pocus techfee", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 776.00, "discounted_cash": 776.00, "minimum": 315.02, "maximum": 331.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 331.60, "count": "1 through 10", "median_amount": 346.83, "10th_percentile": 346.83, "90th_percentile": 346.83, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Echo exam of abdomen", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 776.00, "discounted_cash": 776.00, "minimum": 315.02, "maximum": 331.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 331.60, "count": "1 through 10", "median_amount": 346.83, "10th_percentile": 346.83, "90th_percentile": 346.83, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us aorta complete", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 769.00, "discounted_cash": 769.00, "minimum": 315.02, "maximum": 331.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 331.60, "count": "1 through 10", "median_amount": 332.38, "10th_percentile": 323.03, "90th_percentile": 341.73, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "1 through 10", "median_amount": 515.23, "10th_percentile": 515.23, "90th_percentile": 515.23, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam abdo back wall comp", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 769.00, "discounted_cash": 769.00, "minimum": 315.02, "maximum": 331.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 331.60, "count": "1 through 10", "median_amount": 332.38, "10th_percentile": 323.03, "90th_percentile": 341.73, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "1 through 10", "median_amount": 515.23, "10th_percentile": 515.23, "90th_percentile": 515.23, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "76775 - aorta us fac ed pocus techfee", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 175.95, "10th_percentile": 175.95, "90th_percentile": 175.95, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam abdo back wall lim", "code_information": [ { "code": "76775", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 175.95, "10th_percentile": 175.95, "90th_percentile": 175.95, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ob us < 14 wks single fetus", "code_information": [ { "code": "76801", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 513.00, "discounted_cash": 513.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us ob < 14 weeks", "code_information": [ { "code": "76801", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 513.00, "discounted_cash": 513.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ob us >= 14 wks sngl fetus", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 513.00, "discounted_cash": 513.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 52.01, "10th_percentile": 52.01, "90th_percentile": 52.01, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us ob > 14 weeks limited", "code_information": [ { "code": "76805", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 513.00, "discounted_cash": 513.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 52.01, "10th_percentile": 52.01, "90th_percentile": 52.01, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "76815 - ob limited us fac ed pocus techfee", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ob us limited fetus(s)", "code_information": [ { "code": "76815", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ob us follow-up per fetus", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us ob follow up", "code_information": [ { "code": "76816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Transvaginal us non-ob", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 477.00, "discounted_cash": 477.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us transvaginal non-ob", "code_information": [ { "code": "76830", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 477.00, "discounted_cash": 477.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam pelvic complete", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 513.00, "discounted_cash": 513.00, "minimum": 315.02, "maximum": 331.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us pelvic complete", "code_information": [ { "code": "76856", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 513.00, "discounted_cash": 513.00, "minimum": 315.02, "maximum": 331.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam pelvic limited", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 315.02, "maximum": 331.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 331.60, "count": "1 through 10", "median_amount": 171.01, "10th_percentile": 171.01, "90th_percentile": 171.01, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us pelvic ltd", "code_information": [ { "code": "76857", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 315.02, "maximum": 331.60, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 331.60, "count": "1 through 10", "median_amount": 171.01, "10th_percentile": 171.01, "90th_percentile": 171.01, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 315.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 331.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us exam scrotum", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 452.00, "discounted_cash": 452.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us scrotum (contents)", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 452.00, "discounted_cash": 452.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us compl joint r-t w/img", "code_information": [ { "code": "76881", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us extremity nonvascular complete left", "code_information": [ { "code": "76881", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "76882 - msk us fac ed pocus techfee", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 345.00, "discounted_cash": 345.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us lmtd jt/nonvasc xtr strux", "code_information": [ { "code": "76882", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 345.00, "discounted_cash": 345.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Echo guide for biopsy", "code_information": [ { "code": "76942", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 192.00, "discounted_cash": 192.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us guided needle placement eo", "code_information": [ { "code": "76942", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 192.00, "discounted_cash": 192.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle localization by xray", "code_information": [ { "code": "77002", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 192.00, "discounted_cash": 192.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr fluoro guidance needle placement eo", "code_information": [ { "code": "77002", "type": "CPT" } ], "standard_charges": [ { 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[ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Breast tomosynthesis bi", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 468.00, "discounted_cash": 468.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mg mammo digital screening bilateral.", "code_information": [ { "code": "77062", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 468.00, "discounted_cash": 468.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "77063 - mammo/screening- bilat", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 145.00, "minimum": 49.76, "maximum": 52.38, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 52.38, "count": "1 through 10", "median_amount": 51.34, "10th_percentile": 51.34, "90th_percentile": 51.34, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 52.38, "count": "1 through 10", "median_amount": 91.20, "10th_percentile": 89.82, "90th_percentile": 94.42, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 52.38, "count": "19", "median_amount": 92.58, "10th_percentile": 92.58, "90th_percentile": 93.11, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 49.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 49.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 49.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 52.38, "count": "1 through 10", "median_amount": 51.34, "10th_percentile": 51.34, "90th_percentile": 51.34, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "1 through 10", "median_amount": 51.34, "10th_percentile": 51.34, "90th_percentile": 51.34, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Breast tomosynthesis bi", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 145.00, "discounted_cash": 145.00, "minimum": 49.76, "maximum": 52.38, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 52.38, "count": "1 through 10", "median_amount": 51.34, "10th_percentile": 51.34, "90th_percentile": 51.34, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 52.38, "count": "1 through 10", "median_amount": 91.20, "10th_percentile": 89.82, "90th_percentile": 94.42, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 52.38, "count": "19", "median_amount": 92.58, "10th_percentile": 92.58, "90th_percentile": 93.11, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 49.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 49.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 49.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 52.38, "count": "1 through 10", "median_amount": 51.34, "10th_percentile": 51.34, "90th_percentile": 51.34, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 52.38, "count": "1 through 10", "median_amount": 51.34, "10th_percentile": 51.34, "90th_percentile": 51.34, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 52.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mg breast tomo 3d digital screening", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 468.00, "discounted_cash": 468.00, "minimum": 123.18, "maximum": 129.66, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 129.66, "count": "1 through 10", "median_amount": 92.58, "10th_percentile": 92.58, "90th_percentile": 92.58, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 123.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 123.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 123.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Scr mammo bi incl cad", "code_information": [ { "code": "77067", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 468.00, "discounted_cash": 468.00, "minimum": 123.18, "maximum": 129.66, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 129.66, "count": "1 through 10", "median_amount": 92.58, "10th_percentile": 92.58, "90th_percentile": 92.58, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 123.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 123.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 123.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 129.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-rays bone length studies", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 491.00, "discounted_cash": 491.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr bone length studies scanograms", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 491.00, "discounted_cash": 491.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "X-rays bone survey complete", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Xr bone survey complete", "code_information": [ { "code": "77075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 393.00, "discounted_cash": 393.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bd bone density dexa app skeleton", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 597.00, "discounted_cash": 597.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 307.40, "10th_percentile": 307.40, "90th_percentile": 307.40, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 391.99, "10th_percentile": 391.99, "90th_percentile": 391.99, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "27", "median_amount": 380.83, "10th_percentile": 380.83, "90th_percentile": 391.99, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 307.40, "10th_percentile": 307.40, "90th_percentile": 307.40, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 307.40, "10th_percentile": 304.62, "90th_percentile": 335.18, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dxa bone density axial", "code_information": [ { "code": "77080", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 597.00, "discounted_cash": 597.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 307.40, "10th_percentile": 307.40, "90th_percentile": 307.40, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 391.99, "10th_percentile": 391.99, "90th_percentile": 391.99, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "27", "median_amount": 380.83, "10th_percentile": 380.83, "90th_percentile": 391.99, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 307.40, "10th_percentile": 307.40, "90th_percentile": 307.40, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "1 through 10", "median_amount": 307.40, "10th_percentile": 304.62, "90th_percentile": 335.18, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm thyroid uptake", "code_information": [ { "code": "78012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyroid uptake measurement", "code_information": [ { "code": "78012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm parathyroid imaging", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1537.00, "discounted_cash": 1537.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Parathyroid planar imaging", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1537.00, "discounted_cash": 1537.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lymph system imaging", "code_information": [ { "code": "78195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1663.00, "discounted_cash": 1663.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm lymphoscintigraphy", "code_information": [ { "code": "78195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1663.00, "discounted_cash": 1663.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Liver and spleen imaging", "code_information": [ { "code": "78215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm liver/spleen static", "code_information": [ { "code": "78215", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Liver & spleen image/flow", "code_information": [ { "code": "78216", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm liver/spleen imaging w/ vascular flow", "code_information": [ { "code": "78216", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatobiliary system imaging", "code_information": [ { "code": "78226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm hepatobiliary imaging", "code_information": [ { "code": "78226", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2019.00, "discounted_cash": 2019.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatobil syst image w/drug", "code_information": [ { "code": "78227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1898.00, "discounted_cash": 1898.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm hepatobiliary imaging w/ drug", "code_information": [ { "code": "78227", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1898.00, "discounted_cash": 1898.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gastric emptying imag study", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1341.00, "discounted_cash": 1341.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm gastric emptying study", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1341.00, "discounted_cash": 1341.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acute gi blood loss imaging", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1290.00, "discounted_cash": 1290.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm gastrointestinal blood loss imaging", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1290.00, "discounted_cash": 1290.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meckels divert exam", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm intestine imaging meckels", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone imaging limited area", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm bone imaging limited", "code_information": [ { "code": "78300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone imaging multiple areas", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1416.00, "discounted_cash": 1416.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm bone imaging multiple areas", "code_information": [ { "code": "78305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1416.00, "discounted_cash": 1416.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone imaging whole body", "code_information": [ { "code": "78306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1657.00, "discounted_cash": 1657.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm bone imaging whole body", "code_information": [ { "code": "78306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1657.00, "discounted_cash": 1657.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bone imaging 3 phase", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1887.00, "discounted_cash": 1887.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "1 through 10", "median_amount": 728.68, "10th_percentile": 728.68, "90th_percentile": 728.68, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm bone three phase study", "code_information": [ { "code": "78315", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1887.00, "discounted_cash": 1887.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "1 through 10", "median_amount": 728.68, "10th_percentile": 728.68, "90th_percentile": 728.68, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ht muscle image spect sing", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4380.00, "discounted_cash": 4380.00, "minimum": 1341.77, "maximum": 1412.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm myocardial spect single study", "code_information": [ { "code": "78451", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4380.00, "discounted_cash": 4380.00, "minimum": 1341.77, "maximum": 1412.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ht muscle image spect mult", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4380.00, "discounted_cash": 4380.00, "minimum": 1341.77, "maximum": 1412.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1412.39, "count": "1 through 10", "median_amount": 1875.13, "10th_percentile": 1875.13, "90th_percentile": 1875.13, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm myocardial spect rest and stress", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 4380.00, "discounted_cash": 4380.00, "minimum": 1341.77, "maximum": 1412.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1412.39, "count": "1 through 10", "median_amount": 1875.13, "10th_percentile": 1875.13, "90th_percentile": 1875.13, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1341.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1412.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gated heart planar single", "code_information": [ { "code": "78472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1880.00, "discounted_cash": 1880.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm cardiac muga", "code_information": [ { "code": "78472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1880.00, "discounted_cash": 1880.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lung ventilation imaging", "code_information": [ { "code": "78579", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1330.00, "discounted_cash": 1330.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm lung ventilation imaging", "code_information": [ { "code": "78579", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1330.00, "discounted_cash": 1330.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lung perfusion imaging", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm lung perfusion imaging", "code_information": [ { "code": "78580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lung ventilat&perfus imaging", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2315.00, "discounted_cash": 2315.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm lung vent/perf imaging", "code_information": [ { "code": "78582", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2315.00, "discounted_cash": 2315.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Kidney imaging morphol", "code_information": [ { "code": "78700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm kidney imaging", "code_information": [ { "code": "78700", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "K flow/funct image w/o drug", "code_information": [ { "code": "78707", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1625.00, "discounted_cash": 1625.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm kidney morphology w/ vascular flow", "code_information": [ { "code": "78707", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1625.00, "discounted_cash": 1625.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "K flow/funct image w/drug", "code_information": [ { "code": "78708", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1625.00, "discounted_cash": 1625.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm kidney imaging single w/ pharm", "code_information": [ { "code": "78708", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1625.00, "discounted_cash": 1625.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "K flow/funct image multiple", "code_information": [ { "code": "78709", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1693.00, "discounted_cash": 1693.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm kidney imaging multiple w/+w/o pharm", "code_information": [ { "code": "78709", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1693.00, "discounted_cash": 1693.00, "minimum": 553.23, "maximum": 582.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 553.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 582.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm ureteral reflux study", "code_information": [ { "code": "78740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ureteral reflux study", "code_information": [ { "code": "78740", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm testicular imaging w/ vascular flow", "code_information": [ { "code": "78761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Testicular imaging w/flow", "code_information": [ { "code": "78761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm tumor loc single area", "code_information": [ { "code": "78800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rp loclzj tum 1 area 1 d img", "code_information": [ { "code": "78800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1267.00, "discounted_cash": 1267.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nm tumor loc multiple areas", "code_information": [ { "code": "78801", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1791.00, "discounted_cash": 1791.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rp loclzj tum 2+area 1+d img", "code_information": [ { "code": "78801", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1791.00, "discounted_cash": 1791.00, "minimum": 413.00, "maximum": 434.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 413.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 434.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Basic metabolic panel", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 158.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metabolic panel total ca", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 158.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bill only 80050 general health panel", "code_information": [ { "code": "80050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 194.00, "discounted_cash": 194.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "General health panel", "code_information": [ { "code": "80050", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 194.00, "discounted_cash": 194.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electrolyte panel", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 139.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Comprehen metabolic panel", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 200.00, "discounted_cash": 200.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Comprehensive metabolic panel", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 200.00, "discounted_cash": 200.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lipid panel", "code_information": [ { "code": "80061", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 184.00, "discounted_cash": 184.00, "minimum": 12.72, "maximum": 13.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 13.39, "count": "1 through 10", "median_amount": 94.87, "10th_percentile": 94.87, "90th_percentile": 94.87, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 13.39, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 13.39, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 13.39, "count": "22", "median_amount": 117.53, "10th_percentile": 59.94, "90th_percentile": 120.81, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 13.39, "count": "189", "median_amount": 117.53, "10th_percentile": 114.02, "90th_percentile": 120.81, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 13.39, "count": "1 through 10", "median_amount": 114.02, "10th_percentile": 114.02, "90th_percentile": 114.02, "methodology": "fee schedule" }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 12.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 12.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 12.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 13.39, "count": "1 through 10", "median_amount": 94.87, "10th_percentile": 94.87, "90th_percentile": 94.87, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 13.39, "count": "34", "median_amount": 94.87, "10th_percentile": 60.81, "90th_percentile": 123.28, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 13.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Renal function panel", "code_information": [ { "code": "80069", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 612.00, "discounted_cash": 612.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatic function panel", "code_information": [ { "code": "80076", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 308.00, "discounted_cash": 308.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of vancomycin", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 47.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vancomycin level", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 47.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug assay vedolizumab", "code_information": [ { "code": "80280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 233.00, "discounted_cash": 233.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vedolizumab ab s qst", "code_information": [ { "code": "80280", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 233.00, "discounted_cash": 233.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urinalysis auto w/o scope", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urinalysis dipstick only", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Microscopic exam of urine", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ua microscopic", "code_information": [ { "code": "81015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "81025 urine pregnancy test visual color cmprsn meths techfee", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31.00, "discounted_cash": 31.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine pregnancy test", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31.00, "discounted_cash": 31.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bcr abl1/abl1 % qst", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.00, "discounted_cash": 146.00, "minimum": 155.76, "maximum": 163.96, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 155.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 155.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 155.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bcr/abl1 gene major bp", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.00, "discounted_cash": 146.00, "minimum": 155.76, "maximum": 163.96, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 155.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 155.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 155.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 163.96, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bcr abl1/abl1 % (is) qst", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.00, "discounted_cash": 146.00, "minimum": 137.60, "maximum": 144.84, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 137.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 137.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 137.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bcr/abl1 gene minor bp", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.00, "discounted_cash": 146.00, "minimum": 137.60, "maximum": 144.84, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 137.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 137.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 137.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 144.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "81243 - add on", "code_information": [ { "code": "81243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 577.00, "discounted_cash": 577.00, "minimum": 54.19, "maximum": 57.04, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fmr1 gene detection", "code_information": [ { "code": "81243", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 577.00, "discounted_cash": 577.00, "minimum": 54.19, "maximum": 57.04, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Htt gene detc abnor alleles", "code_information": [ { "code": "81271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1082.00, "discounted_cash": 1082.00, "minimum": 130.15, "maximum": 137.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Huntington disease mutation analysis qst", "code_information": [ { "code": "81271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1082.00, "discounted_cash": 1082.00, "minimum": 130.15, "maximum": 137.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "81329 - add on", "code_information": [ { "code": "81329", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 577.00, "discounted_cash": 577.00, "minimum": 130.15, "maximum": 137.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Smn1 gene dos/deletion alys", "code_information": [ { "code": "81329", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 577.00, "discounted_cash": 577.00, "minimum": 130.15, "maximum": 137.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 130.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 137.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "81479 cdkn2a sequencing and deletion/duplication", "code_information": [ { "code": "81479", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 195.00, "discounted_cash": 195.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Unlisted molecular pathology", "code_information": [ { "code": "81479", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 195.00, "discounted_cash": 195.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Multi vaginal panel (genexpert)", "code_information": [ { "code": "81514", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 142.00, "discounted_cash": 142.00, "minimum": 249.84, "maximum": 262.99, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 262.99, "count": "1 through 10", "median_amount": 90.61, "10th_percentile": 90.61, "90th_percentile": 90.61, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nfct ds bv&vaginitis dna alg", "code_information": [ { "code": "81514", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 142.00, "discounted_cash": 142.00, "minimum": 249.84, "maximum": 262.99, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 262.99, "count": "1 through 10", "median_amount": 90.61, "10th_percentile": 90.61, "90th_percentile": 90.61, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 249.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 249.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 249.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 262.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetone", "code_information": [ { "code": "82009", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Test for acetone/ketones", "code_information": [ { "code": "82009", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albumin level", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of serum albumin", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Microalbumin/creatinine ratio urine", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 20.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ur albumin quantitative", "code_information": [ { "code": "82043", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 20.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Microalbumin level urine", "code_information": [ { "code": "82044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 23.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ur albumin semiquantitative", "code_information": [ { "code": "82044", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 23.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of breath ethanol", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 32.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Breath alcohol", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 32.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Amylase level", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 112.00, "discounted_cash": 112.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 112.00, "discounted_cash": 112.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bilirubin total", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 59.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bilirubin direct", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 59.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Occult blood feces", "code_information": [ { "code": "82270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "minimum": 4.16, "maximum": 4.38, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 4.38, "count": "1 through 10", "median_amount": 19.04, "10th_percentile": 19.04, "90th_percentile": 19.04, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 4.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 4.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 4.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Occult blood stool diagnostic", "code_information": [ { "code": "82270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "minimum": 4.16, "maximum": 4.38, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 4.38, "count": "1 through 10", "median_amount": 19.04, "10th_percentile": 19.04, "90th_percentile": 19.04, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 4.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 4.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Occult bld feces 1-3 tests", "code_information": [ { "code": "82272", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent 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amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "82300-heavy metals comprehensive panel urine", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 459.00, "discounted_cash": 459.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of cadmium", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 459.00, "discounted_cash": 459.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vitamin d 25 hydroxy", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 103.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vitamin d 25 hydroxy level", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 103.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of calcium", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 111.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pth intact (icma) and ionized calcium qst", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 111.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "82330 - pth intact (icma) and ionized calcium qst", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 111.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of calcium", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 111.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calculus spectroscopy", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.00, "discounted_cash": 76.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Stone analysis", "code_information": [ { "code": "82365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 76.00, "discounted_cash": 76.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay blood carbon dioxide", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carbon dioxide level", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay urine catecholamines", "code_information": [ { "code": "82382", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.00, "discounted_cash": 164.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pheochromocytoma evaluation quest", "code_information": [ { "code": "82382", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.00, "discounted_cash": 164.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of blood chloride", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chloride level", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay bld/serum cholesterol", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "minimum": 4.13, "maximum": 4.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 4.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 4.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 4.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lipoprotein", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "minimum": 4.13, "maximum": 4.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 4.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 4.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 4.13, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 4.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of ck (cpk)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 112.00, "discounted_cash": 112.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Creatine kinase", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 112.00, "discounted_cash": 112.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of creatinine", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 93.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Creatinine", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 93.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "82570 amino acid analysis lc/ms urine qst", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 695.00, "discounted_cash": 695.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine creatinine", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 695.00, "discounted_cash": 695.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vitamin b-12", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 53.00, "discounted_cash": 53.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vitamin b12 level", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 53.00, "discounted_cash": 53.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 47.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 47.00, "discounted_cash": 47.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of folic acid serum", "code_information": [ { "code": "82746", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Folate level", "code_information": [ { "code": "82746", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "82784 - igg qst add on", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay iga/igd/igg/igm each", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood gas arterial", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 222.00, "discounted_cash": 222.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood gases any combination", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 222.00, "discounted_cash": 222.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay glucose blood quant", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 48.00, "minimum": 3.73, "maximum": 3.93, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose level", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 48.00, "minimum": 3.73, "maximum": 3.93, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 3.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 3.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 3.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 3.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose 1 hour", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "minimum": 12.23, "maximum": 12.87, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 12.87, "count": "1 through 10", "median_amount": 36.77, "10th_percentile": 36.77, "90th_percentile": 36.77, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 12.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 12.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 12.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose tolerance test (gtt)", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "minimum": 12.23, "maximum": 12.87, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 12.87, "count": "1 through 10", "median_amount": 36.77, "10th_percentile": 36.77, "90th_percentile": 36.77, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 12.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 12.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 12.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 12.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "82948 glucose blood reagent strip techfee", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucose blood test", "code_information": [ { "code": "82962", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "83018-heavy metals comprehensive panel urine", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 459.00, "discounted_cash": 459.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heavy metal quant each nes", "code_information": [ { "code": "83018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 459.00, "discounted_cash": 459.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glycosylated hemoglobin test", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 158.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hgb a1c", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 158.00, "discounted_cash": 158.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "83516", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 475.00, "discounted_cash": 475.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunoassay nonantibody", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 475.00, "discounted_cash": 475.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "83519-myasthenia gravis panel 2 with reflex to musk antibody qst", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 217.00, "discounted_cash": 217.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ria nonantibody", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 217.00, "discounted_cash": 217.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunoassay quant nos nonab", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 233.00, "discounted_cash": 233.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vedolizumab qn s qst", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 233.00, "discounted_cash": 233.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of iron", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 23.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iron level", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 23.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iron binding test", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 140.00, "discounted_cash": 140.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iron panel w/ ferritin", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 140.00, "discounted_cash": 140.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of lactic acid", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 166.00, "discounted_cash": 166.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lactic acid level", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 166.00, "discounted_cash": 166.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lactate (ld) (ldh) enzyme", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.00, "discounted_cash": 108.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ld pleural fluid qst", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.00, "discounted_cash": 108.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "83655-heavy metals comprehensive panel urine", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 459.00, "discounted_cash": 459.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of lead", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 459.00, "discounted_cash": 459.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 143.00, "discounted_cash": 143.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lipase level", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 143.00, "discounted_cash": 143.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cholesterol ldl", "code_information": [ { "code": "83704", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 113.00, "discounted_cash": 113.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lipoprotein bld quan part", "code_information": [ { "code": "83704", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 113.00, "discounted_cash": 113.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of lipoprotein", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cholesterol hdl", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of magnesium", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.00, "discounted_cash": 108.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium level", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 108.00, "discounted_cash": 108.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "83825-heavy metals comprehensive panel urine", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 459.00, "discounted_cash": 459.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of mercury", "code_information": [ { "code": "83825", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 459.00, "discounted_cash": 459.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of natriuretic peptide", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.00, "discounted_cash": 278.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "B-type natriuretic peptide", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 278.00, "discounted_cash": 278.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "83970 - pth intact (icma) and ionized calcium qst", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 111.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of parathormone", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 111.00, "discounted_cash": 111.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alkaline phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay alkaline phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 93.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phosphorus level", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 93.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of serum potassium", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 59.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Potassium level", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 59.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "84133 - potassium random urine with creatinine", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 14.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urine potassium", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 14.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prealbumin", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Procalcitonin (pct)", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 274.00, "discounted_cash": 274.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Procalcitonin qst", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 274.00, "discounted_cash": 274.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of prolactin", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 266.00, "discounted_cash": 266.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prolactin qst", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 266.00, "discounted_cash": 266.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of psa complexed", "code_information": [ { "code": "84152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 78.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Psa diagnostic", "code_information": [ { "code": "84152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 78.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of psa total", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 196.00, "discounted_cash": 196.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Psa-total", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 196.00, "discounted_cash": 196.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "84154 psa (free and total) qst", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 23.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of psa free", "code_information": [ { "code": "84154", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 23.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of protein serum", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 67.00, "discounted_cash": 67.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein total", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 67.00, "discounted_cash": 67.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "84156-protein total and protein electrophoresis random urine (refl) qst", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of protein urine", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of protein other", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 73.00, "discounted_cash": 73.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein cerebrospinal fluid", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 73.00, "discounted_cash": 73.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "84165 - add on", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein e-phoresis serum", "code_information": [ { "code": "84165", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 27.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "84166-protein total and protein electrophoresis random urine (refl) qst", "code_information": [ { "code": "84166", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein e-phoresis/urine/csf", "code_information": [ { "code": "84166", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "84182 anti-synthetase panel 1 qst", "code_information": [ { "code": "84182", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 115.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein western blot test", "code_information": [ { "code": "84182", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 115.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of sex hormone globul", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 32.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sex hormone binding globulin qst", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 32.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of serum sodium", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium level", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "84302 electrolytes feces qst", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 49.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of sweat sodium", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 49.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "84311 electrolytes feces qst", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 49.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Spectrophotometry", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 49.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of free testosterone", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Testosterone free qst", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of total testosterone", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 80.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Testosteronefree(dialysis)totalms qst", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 80.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of thyroglobulin", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 212.00, "discounted_cash": 212.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyroglobulin lc/ms/ms quest", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 212.00, "discounted_cash": 212.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of free thyroxine", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 32.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Free t4 level", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 32.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay thyroid stim hormone", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 185.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tsh", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 185.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aspartate aminotransferase", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Transferase (ast) (sgot)", "code_information": [ { "code": "84450", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alanine amino (alt) (sgpt)", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 59.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alanine aminotransferase", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 59.00, "discounted_cash": 59.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 7.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Da iron profile -transferrin -ferritin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 7.00, "discounted_cash": 7.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of triglycerides", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "minimum": 5.45, "maximum": 5.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Triglycerides", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "minimum": 5.45, "maximum": 5.74, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 5.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Free assay (ft-3)", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 57.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Free t3", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 57.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of troponin quant", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 41.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hs troponin-i", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 41.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of troponin qual", "code_information": [ { "code": "84512", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 187.00, "discounted_cash": 187.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Troponin-i", "code_information": [ { "code": "84512", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 187.00, "discounted_cash": 187.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of urea nitrogen", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 80.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood urea nitrogen", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 80.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Assay of blood/uric acid", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 89.00, "discounted_cash": 89.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Uric acid", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 89.00, "discounted_cash": 89.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Beta hcg qualitative", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 97.00, "discounted_cash": 97.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chorionic gonadotropin test", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 97.00, "discounted_cash": 97.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Beta hcg qualitative urine", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chorionic gonadotropin assay", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": ".manual differential (lchn)", "code_information": [ { "code": "85007", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 124.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bl smear w/diff wbc count", "code_information": [ { "code": "85007", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 124.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hematocrit", "code_information": [ { "code": "85014", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 38.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hemoglobin", "code_information": [ { "code": "85018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cbc w/ differential", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 119.00, "discounted_cash": 119.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complete cbc w/auto diff wbc", "code_information": [ { "code": "85025", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 119.00, "discounted_cash": 119.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cbc without differential", "code_information": [ { "code": "85027", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 22.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complete cbc automated", "code_information": [ { "code": "85027", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 22.00, "discounted_cash": 22.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Automated reticulocyte count", "code_information": [ { "code": "85045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Retic count", "code_information": [ { "code": "85045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Automated platelet count", "code_information": [ { "code": "85049", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Platelet count", "code_information": [ { "code": "85049", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "85060-peripheral blood smear", "code_information": [ { "code": "85060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 49.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood smear interpretation", "code_information": [ { "code": "85060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 49.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clot factor viii ahg 1 stage", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1845.00, "discounted_cash": 1845.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Von willebrand panel qst", "code_information": [ { "code": "85240", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1845.00, "discounted_cash": 1845.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clot factor ix ptc/chrstmas", "code_information": [ { "code": "85250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 423.00, "discounted_cash": 423.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Factor ix activity clotting qst", "code_information": [ { "code": "85250", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 423.00, "discounted_cash": 423.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Clot factor xi pta", "code_information": [ { "code": "85270", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 411.00, "discounted_cash": 411.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 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Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein c activity qst", "code_information": [ { "code": "85303", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 178.00, "discounted_cash": 178.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", 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"85306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 172.00, "discounted_cash": 172.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", 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remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protein s activity qst", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 172.00, "discounted_cash": 172.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D-dimer", "code_information": [ { "code": "85379", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fibrin degradation quant", "code_information": [ { "code": "85379", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inr", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 64.00, "discounted_cash": 64.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prothrombin time", "code_information": [ { "code": "85610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 64.00, "discounted_cash": 64.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "85613 - add on", "code_information": [ { "code": "85613", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Russell viper venom diluted", "code_information": [ { "code": "85613", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Esr (erythrocyte sedimentation rate)", "code_information": [ { "code": "85651", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 68.00, "discounted_cash": 68.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rbc sed rate nonautomated", "code_information": [ { "code": "85651", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 68.00, "discounted_cash": 68.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thromboplastin time partial", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2525.00, "discounted_cash": 2525.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Von willebrand disease panel with collagen binding assay (cba) qst", "code_information": [ { "code": "85730", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2525.00, "discounted_cash": 2525.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86003 respiratory allergy profile region xi: azcoid qst", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 13.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Allg spec ige crude xtrc ea", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 13.00, "discounted_cash": 13.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ana screen ifa w/rfx titer pattern qst", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antinuclear antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "C-reactive protein", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 20.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86146", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 475.00, "discounted_cash": 475.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Beta-2 glycoprotein antibody", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 475.00, "discounted_cash": 475.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86147", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 475.00, "discounted_cash": 475.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiolipin antibody ea ig", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 475.00, "discounted_cash": 475.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86160-complement component c3 c4 qst", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 50.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complement antigen", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 50.00, "discounted_cash": 50.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complement total (ch50)", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 41.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Complement total (ch50) qst", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 41.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ccp antibody", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 124.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ccp antibody igg ael", "code_information": [ { "code": "86200", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 124.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dna (ds) ab qst", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 74.00, "discounted_cash": 74.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dna antibody native", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 74.00, "discounted_cash": 74.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nuclear antigen antibody", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 141.00, "discounted_cash": 141.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sm/rnp ab qst", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 141.00, "discounted_cash": 141.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86255 - add on", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 288.00, "discounted_cash": 288.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fluorescent antibody screen", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 288.00, "discounted_cash": 288.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heterophile antibody screen", "code_information": [ { "code": "86308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mononucleosis screen", "code_information": [ { "code": "86308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86331 - hypersensitivity pneumonitis screen qst", "code_information": [ { "code": "86331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunodiffusion ouchterlony", "code_information": [ { "code": "86331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86355 - add on", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 101.00, "discounted_cash": 101.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "B cells total count", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 101.00, "discounted_cash": 101.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86357 - add on", "code_information": [ { "code": "86357", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 94.00, "discounted_cash": 94.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nk cells total count", "code_information": [ { "code": "86357", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 94.00, "discounted_cash": 94.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86359 - add on", "code_information": [ { "code": "86359", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 101.00, "discounted_cash": 101.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "T cells total count", "code_information": [ { "code": "86359", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 101.00, "discounted_cash": 101.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86360 - add on", "code_information": [ { "code": "86360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 197.00, "discounted_cash": 197.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "T cell absolute count/ratio", "code_information": [ { "code": "86360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 197.00, "discounted_cash": 197.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86364 - transglutaminase antibody qst", "code_information": [ { "code": "86364", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 242.00, "discounted_cash": 242.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tiss trnsgltmnase ea ig clas", "code_information": [ { "code": "86364", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 242.00, "discounted_cash": 242.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neutralization test viral", "code_information": [ { "code": "86382", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polio virus 1 ab qst", "code_information": [ { "code": "86382", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86431 - add on", "code_information": [ { "code": "86431", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31.00, "discounted_cash": 31.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rheumatoid factor quant", "code_information": [ { "code": "86431", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31.00, "discounted_cash": 31.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tb intradermal test", "code_information": [ { "code": "86580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 53.00, "discounted_cash": 53.00, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tb skin test", "code_information": [ { "code": "86580", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 53.00, "discounted_cash": 53.00, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tuberculin purified protein derivative 50 tu/1 ml id sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "86580", "type": "CPT" }, { "code": "49281EA0752EA21", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 203.49, "discounted_cash": 203.49, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "82533-acth stimulation 2 specimens qst", "code_information": [ { "code": "86596", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 405.00, "discounted_cash": 405.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Voltage-gtd ca chnl antb ea", "code_information": [ { "code": "86596", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 405.00, "discounted_cash": 405.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86609 - hypersensitivity pneumonitis screen qst", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bacterium antibody", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86611-b. henselae ab (igg igm) w/reflex to titers", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 99.00, "discounted_cash": 99.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bartonella antibody", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 99.00, "discounted_cash": 99.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bordetella antibody", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 240.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bordetella pertussis/parapertussis qst", "code_information": [ { "code": "86615", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 240.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86645 add on", "code_information": [ { "code": "86645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cmv antibody igm", "code_information": [ { "code": "86645", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epstein barr virus ab panel qst", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 151.00, "discounted_cash": 151.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epstein-barr capsid vca", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 151.00, "discounted_cash": 151.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86666-anaplasma phgocytophilum ab (igg igm) qst", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 185.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ehrlichia antibody", "code_information": [ { "code": "86666", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 185.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Haemophilus influenzae type b antibody (igg)", "code_information": [ { "code": "86684", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 87.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hemophilus influenza antibdy", "code_information": [ { "code": "86684", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 87.00, "discounted_cash": 87.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Herpes simplex type 1 test", 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"payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hsv 1 igg type specific ab qst", "code_information": [ { "code": "86695", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Herpes simplex type 2 test", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 29.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed 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"payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mumps antibody", "code_information": [ { "code": "86735", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.00, "discounted_cash": 92.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86738-mycoplasma pneumoniae ab (igg igm)", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 78.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mycoplasma antibody", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 78.00, "discounted_cash": 78.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86747-parvovirus b19 abs (igg igm) qst", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Parvovirus antibody", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Babesia duncani (wa1) antibody (igg) ifa", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.00, "discounted_cash": 144.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protozoa antibody nos", "code_information": [ { "code": "86753", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.00, "discounted_cash": 144.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Respiratory syncytial virus", "code_information": [ { "code": "86756", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.00, "discounted_cash": 92.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Respiratory virus antibody", "code_information": [ { "code": "86756", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.00, "discounted_cash": 92.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86765-measles antibodies (igg igm) diagnostic qst", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 291.00, "discounted_cash": 291.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rubeola antibody", "code_information": [ { "code": "86765", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 291.00, "discounted_cash": 291.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86790-hantavirus ab (igg igm) qst", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 80.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Virus antibody nos", "code_information": [ { "code": "86790", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 80.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86800 - add on", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 25.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thyroglobulin antibody", "code_information": [ { "code": "86800", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 25.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Antibody screen gel 2", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 29.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "1 through 10", "median_amount": 18.38, "10th_percentile": 18.27, "90th_percentile": 19.04, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rbc antibody screen", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 29.00, "discounted_cash": 29.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "1 through 10", "median_amount": 18.38, "10th_percentile": 18.27, "90th_percentile": 19.04, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Coombs test direct", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 110.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dat igg/c3", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 110.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abo/rh", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.00, "discounted_cash": 118.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "16", "median_amount": 75.51, "10th_percentile": 70.26, "90th_percentile": 109.44, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood typing serologic abo", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.00, "discounted_cash": 118.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "16", "median_amount": 75.51, "10th_percentile": 70.26, "90th_percentile": 109.44, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "86901 - add on", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 110.00, "minimum": 40.34, "maximum": 42.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 42.46, "count": "15", "median_amount": 70.26, "10th_percentile": 70.26, "90th_percentile": 138.83, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood typing serologic rh(d)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 110.00, "minimum": 40.34, "maximum": 42.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 42.46, "count": "15", "median_amount": 70.26, "10th_percentile": 70.26, "90th_percentile": 138.83, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ahg crossmatch", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 442.00, "discounted_cash": 442.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Compatibility test antiglob", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 442.00, "discounted_cash": 442.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87015 - add on", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Specimen infect agnt concntj", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood culture", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 237.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood culture for bacteria", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 237.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87045 - add on", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Feces culture aerobic bact", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Body fluid culture", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.00, "discounted_cash": 135.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Culture othr specimn aerobic", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.00, "discounted_cash": 135.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cultr bacteria except blood", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.00, "discounted_cash": 92.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wound culture", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 92.00, "discounted_cash": 92.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Culture screen only", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Group b strep (genexpert)", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine culture", "code_information": [ { "code": "87086", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 139.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Urine culture/colony count", "code_information": [ { "code": "87086", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 139.00, "discounted_cash": 139.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cultfungskinhairnail koh final qst", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fungus isolation culture", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 48.00, "discounted_cash": 48.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87103 - add on", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Blood fungus culture", "code_information": [ { "code": "87103", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87106 - add on", "code_information": [ { "code": "87106", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fungi identification yeast", "code_information": [ { "code": "87106", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87107 - add on", "code_information": [ { "code": "87107", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fungi identification mold", "code_information": [ { "code": "87107", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 45.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87116 - add on", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 93.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mycobacteria culture", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 93.00, "discounted_cash": 93.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Culture typing glc/hplc", "code_information": [ { "code": "87143", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 69.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gas liquid chromatography", "code_information": [ { "code": "87143", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 69.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87149 - add on", "code_information": [ { "code": "87149", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 58.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dna/rna direct probe", "code_information": [ { "code": "87149", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 58.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lchn nuc90", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.00, "discounted_cash": 146.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Microbe susceptible mic", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.00, "discounted_cash": 146.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87205 smear gram stain w/interpretation", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 77.00, "discounted_cash": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Smear gram stain", "code_information": [ { "code": "87205", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 77.00, "discounted_cash": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87206 - add on", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44.00, "discounted_cash": 44.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Smear fluorescent/acid stai", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44.00, "discounted_cash": 44.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Smear wet mount saline/ink", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 37.00, "discounted_cash": 37.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wet prep", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 37.00, "discounted_cash": 37.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hiv-1 ag w/hiv-1 & hiv-2 ab", "code_information": [ { "code": "87389", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 185.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prep hiv-1/2 antigen and antibodies fourth generation with reflexes qst", "code_information": [ { "code": "87389", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 185.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Influenza a and b (sofia)", "code_information": [ { "code": "87400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 104.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Influenza a/b ag ia", "code_information": [ { "code": "87400", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 104.00, "discounted_cash": 104.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Coronavirus sars ag (sofia)", "code_information": [ { "code": "87426", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.00, "discounted_cash": 144.00, "minimum": 33.56, "maximum": 35.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 33.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 33.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 33.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sarscov coronavirus ag ia", "code_information": [ { "code": "87426", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.00, "discounted_cash": 144.00, "minimum": 33.56, "maximum": 35.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 33.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 33.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 33.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 35.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87427 - add on", "code_information": [ { "code": "87427", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.00, "discounted_cash": 91.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Shiga-like toxin ag ia", "code_information": [ { "code": "87427", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 91.00, "discounted_cash": 91.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87449 - add on", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 28.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", 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total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ag detect nos ia mult", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 28.00, "discounted_cash": 28.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87481 candida species amp probe bill only", "code_information": [ { "code": "87481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Candida dna amp probe", "code_information": [ { "code": "87481", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87581 - add on", "code_information": [ { "code": "87486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.00, "discounted_cash": 347.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chylmd pneum dna amp probe", "code_information": [ { "code": "87486", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 347.00, "discounted_cash": 347.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chlamydia trachomatis rna tma uro qst", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82.00, "discounted_cash": 82.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chylmd trach dna amp probe", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 82.00, "discounted_cash": 82.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "C diff amplified probe", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 49.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "C. diff int qc", "code_information": [ { "code": "87493", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 49.00, "discounted_cash": 49.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytomeg dna quant", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 407.00, "discounted_cash": 407.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytomegalovirus dna qn rt pcr qst", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 407.00, "discounted_cash": 407.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87510 gardnerella vaginalis bill only", "code_information": [ { "code": "87510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 41.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gardner vag dna dir probe", "code_information": [ { "code": "87510", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 41.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87511 gardnerella vaginalis amp probe bill only", "code_information": [ { "code": "87511", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gardner vag dna amp probe", "code_information": [ { "code": "87511", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87529-herpes simplex virus t1 and 2 dna qu. real time pcr qst", "code_information": [ { "code": "87529", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.00, "discounted_cash": 164.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hsv dna amp probe", "code_information": [ { "code": "87529", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 164.00, "discounted_cash": 164.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And 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calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87486 - add on", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 346.00, "discounted_cash": 346.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "M.pneumon dna amp probe", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 346.00, "discounted_cash": 346.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87591 - add on", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 103.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "N.gonorrhoeae dna amp prob", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 103.00, "discounted_cash": 103.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87624 hpv high risk", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hpv high-risk types", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 70.00, "discounted_cash": 70.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87625 hpv 16/18 genotypes", "code_information": [ { "code": "87625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hpv types 16 & 18 only", "code_information": [ { "code": "87625", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 81.00, "discounted_cash": 81.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87626 hpv high risk 16/18 genotypes", "code_information": [ { "code": "87626", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 151.00, "discounted_cash": 151.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hpv sep hi-rsk typ&pool rslt", "code_information": [ { "code": "87626", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 151.00, "discounted_cash": 151.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sars cov-2(covid-19) pcr", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.00, "discounted_cash": 144.00, "minimum": 48.74, "maximum": 51.31, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 48.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 48.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 48.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sars-cov-2 covid-19 amp prb", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 144.00, "discounted_cash": 144.00, "minimum": 48.74, "maximum": 51.31, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 48.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 48.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 48.74, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 51.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sars-cov-2 (covid-19)/flu/rsv (genexpert)", "code_information": [ { "code": "87637", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 454.00, "discounted_cash": 454.00, "minimum": 135.50, "maximum": 142.63, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 135.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 135.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 135.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sarscov2&inf a&b&rsv amp prb", "code_information": [ { "code": "87637", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 454.00, "discounted_cash": 454.00, "minimum": 135.50, "maximum": 142.63, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 135.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 135.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 135.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 142.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mr-staph dna amp probe", "code_information": [ { "code": "87641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 57.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mrsa (genexpert)", "code_information": [ { "code": "87641", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 57.00, "discounted_cash": 57.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Group a strep (genexpert)", "code_information": [ { "code": "87651", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 128.00, "discounted_cash": 128.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strep a dna amp probe", "code_information": [ { "code": "87651", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 128.00, "discounted_cash": 128.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87660 trichomonas vaginalis", "code_information": [ { "code": "87660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 41.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trichomonas vagin dir probe", "code_information": [ { "code": "87660", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 41.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "87661 - add on", "code_information": [ { "code": "87661", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 102.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trichomonas vaginalis amplif", "code_information": [ { "code": "87661", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 102.00, "discounted_cash": 102.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed 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75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": 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"payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": 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"Detect agent nos dna amp", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 215.00, "discounted_cash": 215.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Detect agent nos dna quant", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 290.00, "discounted_cash": 290.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epstein-barr virus dna quant real-time pcr qst", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 290.00, "discounted_cash": 290.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strep a (sofia)", "code_information": [ { "code": "87880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 58.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Strep a assay w/optic", "code_information": [ { "code": "87880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 58.00, "discounted_cash": 58.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88104-cytopath fl nongyn", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.00, "discounted_cash": 155.00, "minimum": 40.34, "maximum": 42.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath fl nongyn smears", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 155.00, "discounted_cash": 155.00, "minimum": 40.34, "maximum": 42.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88106-cytopath concentrate tech", "code_information": [ { "code": "88106", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 147.00, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath fl nongyn filter", "code_information": [ { "code": "88106", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 147.00, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88108 cytopath concentrate tech", "code_information": [ { "code": "88108", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 148.00, "discounted_cash": 148.00, "minimum": 40.34, "maximum": 42.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath concentrate tech", "code_information": [ { "code": "88108", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 148.00, "discounted_cash": 148.00, "minimum": 40.34, "maximum": 42.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88112-special stains group 1", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.00, "discounted_cash": 146.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath cell enhance tech", "code_information": [ { "code": "88112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 146.00, "discounted_cash": 146.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88141-phys. interpretation on abnormal pap", "code_information": [ { "code": "88141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 69.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath c/v interpret", "code_information": [ { "code": "88141", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 69.00, "discounted_cash": 69.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88142-cytopath cv thin layer", "code_information": [ { "code": "88142", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31.00, "discounted_cash": 31.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath c/v thin layer", "code_information": [ { "code": "88142", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 31.00, "discounted_cash": 31.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88160-cytopath smear other", "code_information": [ { "code": "88160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 147.00, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath smear other source", "code_information": [ { "code": "88160", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 147.00, "discounted_cash": 147.00, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88172-cytp dx eval fna 1st ea", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 117.00, "discounted_cash": 117.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytp dx eval fna 1st ea site", "code_information": [ { "code": "88172", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 117.00, "discounted_cash": 117.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88173-cytopath eval fna report", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 312.00, "discounted_cash": 312.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath eval fna report", "code_information": [ { "code": "88173", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 312.00, "discounted_cash": 312.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88175-cytopath c?v auto fluid", "code_information": [ { "code": "88175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 54.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytopath c/v auto fluid redo", "code_information": [ { "code": "88175", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 54.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88177-cytp fna eval ea addl", "code_information": [ { "code": "88177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 62.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytp fna eval ea addl", "code_information": [ { "code": "88177", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 62.00, "discounted_cash": 62.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88262", "code_information": [ { "code": "88262", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 843.00, "discounted_cash": 843.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chromosome analysis 15-20", "code_information": [ { "code": "88262", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 843.00, "discounted_cash": 843.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88271-fish aml cbfb/myh11 qst", "code_information": [ { "code": "88271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 274.00, "discounted_cash": 274.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytogenetics dna probe", "code_information": [ { "code": "88271", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 274.00, "discounted_cash": 274.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88275- fish mds/myeloid panel -5/5q- -7/7q- +820q- qst", "code_information": [ { "code": "88275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 140.00, "discounted_cash": 140.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cytogenetics 100-300", "code_information": [ { "code": "88275", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 140.00, "discounted_cash": 140.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88300-surgical path gross", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 32.00, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Surgical path gross", "code_information": [ { "code": "88300", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 32.00, "discounted_cash": 32.00, "minimum": 25.17, "maximum": 26.50, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.17, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88302-tissue exam by pathologist1", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 66.00, "discounted_cash": 66.00, "minimum": 40.34, "maximum": 42.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88302", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 66.00, "discounted_cash": 66.00, "minimum": 40.34, "maximum": 42.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 40.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 42.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88304-tissue exam by pathologist2", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 88.00, "discounted_cash": 88.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88304", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 88.00, "discounted_cash": 88.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88305-tissue exam by pathologist3", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 148.00, "discounted_cash": 148.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "1 through 10", "median_amount": 91.73, "10th_percentile": 91.73, "90th_percentile": 91.73, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "18", "median_amount": 97.59, "10th_percentile": 64.60, "90th_percentile": 198.98, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "1 through 10", "median_amount": 152.64, "10th_percentile": 152.64, "90th_percentile": 152.64, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "1 through 10", "median_amount": 76.32, "10th_percentile": 76.32, "90th_percentile": 76.32, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88305", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 148.00, "discounted_cash": 148.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "1 through 10", "median_amount": 91.73, "10th_percentile": 91.73, "90th_percentile": 91.73, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "18", "median_amount": 97.59, "10th_percentile": 64.60, "90th_percentile": 198.98, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "1 through 10", "median_amount": 152.64, "10th_percentile": 152.64, "90th_percentile": 152.64, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "1 through 10", "median_amount": 76.32, "10th_percentile": 76.32, "90th_percentile": 76.32, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88307-tissue exam by pathologist1", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 598.00, "discounted_cash": 598.00, "minimum": 369.72, "maximum": 389.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 598.00, "discounted_cash": 598.00, "minimum": 369.72, "maximum": 389.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88309-tissue exam by pathologist2", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 873.00, "discounted_cash": 873.00, "minimum": 839.61, "maximum": 883.80, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tissue exam by pathologist", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 873.00, "discounted_cash": 873.00, "minimum": 839.61, "maximum": 883.80, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88311-decalcify tissue", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Decalcify tissue", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88312-special stains group 1", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 237.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "1 through 10", "median_amount": 99.38, "10th_percentile": 99.38, "90th_percentile": 99.38, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Special stains group 1", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 237.00, "discounted_cash": 237.00, "minimum": 54.92, "maximum": 57.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 57.81, "count": "1 through 10", "median_amount": 99.38, "10th_percentile": 99.38, "90th_percentile": 99.38, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 54.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 57.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88313-special stains group 2", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 171.00, "discounted_cash": 171.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "1 through 10", "median_amount": 71.70, "10th_percentile": 71.70, "90th_percentile": 71.70, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Special stains group 2", "code_information": [ { "code": "88313", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 171.00, "discounted_cash": 171.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "1 through 10", "median_amount": 71.70, "10th_percentile": 71.70, "90th_percentile": 71.70, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88331-path consult intraop 1 bloc", "code_information": [ { "code": "88331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 211.00, "discounted_cash": 211.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Path consult intraop 1 bloc", "code_information": [ { "code": "88331", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 211.00, "discounted_cash": 211.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88332-path consult intraop addl", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 113.00, "discounted_cash": 113.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Path consult intraop addl", "code_information": [ { "code": "88332", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 113.00, "discounted_cash": 113.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88333-intraop cyto path consult 1", "code_information": [ { "code": "88333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 193.00, "minimum": 839.61, "maximum": 883.80, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intraop cyto path consult 1", "code_information": [ { "code": "88333", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 193.00, "discounted_cash": 193.00, "minimum": 839.61, "maximum": 883.80, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 839.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 883.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88334-intraop cyto path cosnsult 2", "code_information": [ { "code": "88334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.00, "discounted_cash": 116.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Intraop cyto path consult 2", "code_information": [ { "code": "88334", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.00, "discounted_cash": 116.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88341-immunohisto antb addl", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 185.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunohisto antb addl slide", "code_information": [ { "code": "88341", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 185.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88342-immunohisto antb 1st stain", "code_information": [ { "code": "88342", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 211.00, "discounted_cash": 211.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "1 through 10", "median_amount": 60.72, "10th_percentile": 60.72, "90th_percentile": 60.72, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunohisto antb 1st stain", "code_information": [ { "code": "88342", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 211.00, "discounted_cash": 211.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "1 through 10", "median_amount": 60.72, "10th_percentile": 60.72, "90th_percentile": 60.72, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88344-immunohisto antibody slide", "code_information": [ { "code": "88344", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 253.00, "discounted_cash": 253.00, "minimum": 369.72, "maximum": 389.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunohisto antibody slide", "code_information": [ { "code": "88344", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 253.00, "discounted_cash": 253.00, "minimum": 369.72, "maximum": 389.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88360-tumor immunohistochem/manual", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 253.00, "discounted_cash": 253.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tumor immunohistochem/manual", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 253.00, "discounted_cash": 253.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88361-tumor immunohistochem/comput", "code_information": [ { "code": "88361", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 252.00, "discounted_cash": 252.00, "minimum": 369.72, "maximum": 389.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tumor immunohistochem/comput", "code_information": [ { "code": "88361", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 252.00, "discounted_cash": 252.00, "minimum": 369.72, "maximum": 389.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88364-instu hybridization (fsh)", "code_information": [ { "code": "88364", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 290.00, "discounted_cash": 290.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insitu hybridization (fish)", "code_information": [ { "code": "88364", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 290.00, "discounted_cash": 290.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88365-instu hybridization (fsh)", "code_information": [ { "code": "88365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 377.00, "discounted_cash": 377.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insitu hybridization (fish)", "code_information": [ { "code": "88365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 377.00, "discounted_cash": 377.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88368-instu hybridization manual", "code_information": [ { "code": "88368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 285.00, "discounted_cash": 285.00, "minimum": 369.72, "maximum": 389.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insitu hybridization manual", "code_information": [ { "code": "88368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 285.00, "discounted_cash": 285.00, "minimum": 369.72, "maximum": 389.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "88377-m/phmtrc alys ishquant/semiq", "code_information": [ { "code": "88377", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 854.00, "discounted_cash": 854.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "M/phmtrc alys ishquant/semiq", "code_information": [ { "code": "88377", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 854.00, "discounted_cash": 854.00, "minimum": 176.12, "maximum": 185.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 176.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 185.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Body fluid cell count", "code_information": [ { "code": "89051", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 116.00, "discounted_cash": 116.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cell count body fluid", 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"payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Crystals synovial fluid quest", "code_information": [ { "code": "89060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 43.00, "discounted_cash": 43.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", 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"payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "90471 immunization administration < 19 yrs - amb immun admin charge", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "1 through 10", "median_amount": 13.81, "10th_percentile": 13.81, "90th_percentile": 13.81, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "16", "median_amount": 29.94, "10th_percentile": 9.55, "90th_percentile": 92.58, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "1 through 10", "median_amount": 17.33, "10th_percentile": 17.33, "90th_percentile": 31.03, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunization admin", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "1 through 10", "median_amount": 13.81, "10th_percentile": 13.81, "90th_percentile": 13.81, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "16", "median_amount": 29.94, "10th_percentile": 9.55, "90th_percentile": 92.58, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "1 through 10", "median_amount": 17.33, "10th_percentile": 17.33, "90th_percentile": 31.03, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "90472  im adm prq id subq/im njxs ea vaccine techfee", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 200.00, "discounted_cash": 200.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Immunization admin each add", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 200.00, "discounted_cash": 200.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis a pediatric vaccine 720 units/0.5 ml preservative free", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90633", "type": "CPT" }, { "code": "58160EA0825EA11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 122.75, "discounted_cash": 122.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis a pediatric vaccine 720 units/0.5 ml preservative free sus", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90633", "type": "CPT" }, { "code": "58160EA0825EA52", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 140.86, "discounted_cash": 140.86, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Haemophilus b conjugate (prpeat) vaccine im inj [lchn]", "drug_information": { "unit": 5.00, "type": "EA" }, "code_information": [ { "code": "90648", "type": "CPT" }, { "code": "49281EA0545EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 195.62, "discounted_cash": 195.62, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Haemophilus b conjugate (prpeat) vaccine im inj [lchn]", "drug_information": { "unit": 5.00, "type": "EA" }, "code_information": [ { "code": "90648", "type": "CPT" }, { "code": "49281EA0545EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 309.92, "discounted_cash": 309.92, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Human papillomavirus vaccine quadrivalent", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90649", "type": "CPT" }, { "code": "00006EA4045EA41", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 344.34, "discounted_cash": 344.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Flu vaccine 3+ yrs im sdv - amb influenza charge", "code_information": [ { "code": "90653", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 65.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iiv adjuvant vaccine im", "code_information": [ { "code": "90653", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 65.00, "discounted_cash": 65.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "90662 influenza high dose (iiv) - er techfee", "code_information": [ { "code": "90662", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 210.00, "discounted_cash": 210.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iiv no prsv increased ag im", "code_information": [ { "code": "90662", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 210.00, "discounted_cash": 210.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pneumococcal 13eavalent conjugate vaccine im susp [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90670", "type": "CPT" }, { "code": "00005EA1971EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 488.82, "discounted_cash": 488.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphtheria/haemophilus/pertussis/tetanus/polio kit [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "90698", "type": "CPT" }, { "code": "49281EA0510EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 227.99, "discounted_cash": 227.99, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphtheria/haemophilus/pertussis/tetanus/polio kit [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "90698", "type": "CPT" }, { "code": "49281EA0511EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 227.99, "discounted_cash": 227.99, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphtheria/tetanus/pertussis (dtap) ped 15 unitsea5 unitsea23 mcg/0.5 ml", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90700", "type": "CPT" }, { "code": "49281EA0286EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 121.59, "discounted_cash": 121.59, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Measles/mumps/rubella virus vaccine ea", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "90707", "type": "CPT" }, { "code": "00006EA4681EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 183.74, "discounted_cash": 183.74, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Poliovirus vaccine inactivated ea", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "90713", "type": "CPT" }, { "code": "49281EA0860EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 926.84, "discounted_cash": 926.84, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphtheriaeatetanus toxoids (dt) ped pediatric sus", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90714", "type": "CPT" }, { "code": "49281EA0225EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 225.95, "discounted_cash": 225.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphtheriaeatetanus toxoids (dt) ped pediatric", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90714", "type": "CPT" }, { "code": "49281EA0278EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 145.76, "discounted_cash": 145.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tetanus/diphth/pertuss (tdap) adult/adol 5 unitsea2 unitsea15.5 mcg/0.5 ml", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90715", "type": "CPT" }, { "code": "49281EA0400EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 154.96, "discounted_cash": 154.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tetanus/diphth/pertuss (tdap) adult/adol 5 unitsea2 unitsea15.5 mcg/0.5 ml sus", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90715", "type": "CPT" }, { "code": "49281EA0400EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 180.38, "discounted_cash": 180.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tetanus/diphtheria/pertussis acel (tdap) 5 unitsea2 unitsea15.5 mcg/0.5 ml im susp [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90715", "type": "CPT" }, { "code": "49281EA0400EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 180.38, "discounted_cash": 180.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pneumococcal 23eapolyvalent vaccine ea", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90732", "type": "CPT" }, { "code": "00006EA4943EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 252.89, "discounted_cash": 252.89, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meningococcal polysaccharide conjugate vaccine im sol [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90734", "type": "CPT" }, { "code": "49281EA0589EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 305.80, "discounted_cash": 305.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis b pediatric vaccine 10 mcg/0.5 ml inj susp [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "90746", "type": "CPT" }, { "code": "58160EA0820EA11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 72.89, "discounted_cash": 72.89, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zoster vaccine inactivated adjuvanted inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "90750", "type": "CPT" }, { "code": "58160EA0823EA11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 370.59, "discounted_cash": 370.59, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zoster vaccine inactivated adjuvanted inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "90750", "type": "CPT" }, { "code": "58160EA0819EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 349.94, "discounted_cash": 349.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Slp auditory processing tx units", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 283.00, "discounted_cash": 283.00, "minimum": 73.06, "maximum": 76.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Speech/hearing therapy", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 283.00, "discounted_cash": 283.00, "minimum": 73.06, "maximum": 76.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 76.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluation of speech fluency", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 403.00, "discounted_cash": 403.00, "minimum": 127.28, "maximum": 133.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 127.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 127.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 127.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Slp evaluation of speech fluency units", "code_information": [ { "code": "92521", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 403.00, "discounted_cash": 403.00, "minimum": 127.28, "maximum": 133.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 127.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 127.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 127.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 133.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluate speech production", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.00, "discounted_cash": 330.00, "minimum": 105.65, "maximum": 111.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 105.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 105.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 105.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Slp eval of speech sound prod units", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.00, "discounted_cash": 330.00, "minimum": 105.65, "maximum": 111.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 105.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 105.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 105.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 111.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Slp eval lang comprehensionexpress unit", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 692.00, "discounted_cash": 692.00, "minimum": 217.59, "maximum": 229.04, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 217.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 217.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 217.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Speech sound lang comprehen", "code_information": [ { "code": "92523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 692.00, "discounted_cash": 692.00, "minimum": 217.59, "maximum": 229.04, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 217.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 217.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 217.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 229.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Behavioral qualitative analysis units", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.00, "discounted_cash": 322.00, "minimum": 103.78, "maximum": 109.24, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 103.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 103.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 103.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Behavral qualit analys voice", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 322.00, "discounted_cash": 322.00, "minimum": 103.78, "maximum": 109.24, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 103.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 103.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 103.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 109.24, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oral function therapy", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 312.00, "discounted_cash": 312.00, "minimum": 80.78, "maximum": 85.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 80.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 80.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 80.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Slp swallow dysfunction oral feed units", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 312.00, "discounted_cash": 312.00, "minimum": 80.78, "maximum": 85.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 80.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 80.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 80.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 85.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluate swallowing function", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 260.00, "discounted_cash": 260.00, "minimum": 66.84, "maximum": 70.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 66.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 66.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 66.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Slp pharyngeal swallow eval units", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 260.00, "discounted_cash": 260.00, "minimum": 66.84, "maximum": 70.36, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 66.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 66.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 66.84, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 70.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Motion fluoroscopy/swallow", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.00, "discounted_cash": 330.00, "minimum": 86.78, "maximum": 91.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 86.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 86.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 86.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Slp fluoroscopic evaluation units", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 330.00, "discounted_cash": 330.00, "minimum": 86.78, "maximum": 91.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 86.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 86.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 86.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 91.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "92950 cardiopulmonary resuscitation", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 871.00, "discounted_cash": 871.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heart/lung resuscitation cpr", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 871.00, "discounted_cash": 871.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "92953 pacing ed tech fee", "code_information": [ { "code": "92953", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1847.00, "discounted_cash": 1847.00, "minimum": 672.57, "maximum": 707.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 672.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 672.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 672.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Temporary external pacing", "code_information": [ { "code": "92953", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1847.00, "discounted_cash": 1847.00, "minimum": 866.03, "maximum": 911.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "92960 cardiovers elect arrhyt x profee", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1881.00, "discounted_cash": 1881.00, "minimum": 672.57, "maximum": 707.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 672.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 672.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 672.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardioversion electric ext", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1881.00, "discounted_cash": 1881.00, "minimum": 672.57, "maximum": 707.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 672.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 672.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 672.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 707.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "93005 ekg - er techfee", "code_information": [ { "code": "93005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "1 through 10", "median_amount": 97.52, "10th_percentile": 62.52, "90th_percentile": 97.52, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "14", "median_amount": 120.81, "10th_percentile": 30.59, "90th_percentile": 124.75, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "101", "median_amount": 84.75, "10th_percentile": 81.14, "90th_percentile": 87.51, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "1 through 10", "median_amount": 112.41, "10th_percentile": 100.50, "90th_percentile": 124.32, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "1 through 10", "median_amount": 97.52, "10th_percentile": 97.52, "90th_percentile": 106.45, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electrocardiogram tracing", "code_information": [ { "code": "93005", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "1 through 10", "median_amount": 97.52, "10th_percentile": 62.52, "90th_percentile": 97.52, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "14", "median_amount": 120.81, "10th_percentile": 30.59, "90th_percentile": 124.75, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "101", "median_amount": 84.75, "10th_percentile": 81.14, "90th_percentile": 87.51, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "1 through 10", "median_amount": 112.41, "10th_percentile": 100.50, "90th_percentile": 124.32, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "1 through 10", "median_amount": 97.52, "10th_percentile": 97.52, "90th_percentile": 106.45, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "93015 cardiovascular stress test performed (with interpretation) charge", "code_information": [ { "code": "93015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1001.00, "discounted_cash": 1001.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiovascular stress test", "code_information": [ { "code": "93015", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1001.00, "discounted_cash": 1001.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "93017 cardiovascular stress test performed charge", "code_information": [ { "code": "93017", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 871.00, "discounted_cash": 871.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiovascular stress test", "code_information": [ { "code": "93017", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 871.00, "discounted_cash": 871.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tte w/doppler complete", "code_information": [ { "code": "93306", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1646.30, "discounted_cash": 1646.30, "minimum": 563.54, "maximum": 593.20, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.20, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 593.20, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 593.20, "count": "1 through 10", "median_amount": 743.53, "10th_percentile": 567.14, "90th_percentile": 919.93, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 593.20, "count": "22", "median_amount": 741.57, "10th_percentile": 541.80, "90th_percentile": 763.67, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 563.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 563.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 563.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 593.20, "count": "1 through 10", "median_amount": 1110.86, "10th_percentile": 1110.86, "90th_percentile": 1110.86, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 593.20, "count": "1 through 10", "median_amount": 853.30, "10th_percentile": 853.30, "90th_percentile": 853.30, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 593.20, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "93308 echo fac ed pocus techfee", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 792.00, "discounted_cash": 792.00, "minimum": 248.44, "maximum": 261.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tte f-up or lmtd", "code_information": [ { "code": "93308", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 792.00, "discounted_cash": 792.00, "minimum": 248.44, "maximum": 261.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "93797 cardiac rehab w/o continuous ecg charge", "code_information": [ { "code": "93797", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 379.00, "discounted_cash": 379.00, "minimum": 129.41, "maximum": 136.22, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiac rehab", "code_information": [ { "code": "93797", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 379.00, "discounted_cash": 379.00, "minimum": 129.41, "maximum": 136.22, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "93798 cardiac rehab with continuous ecg charge", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 379.00, "discounted_cash": 379.00, "minimum": 129.41, "maximum": 136.22, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 136.22, "count": "1 through 10", "median_amount": 169.50, "10th_percentile": 169.50, "90th_percentile": 169.50, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cardiac rehab/monitor", "code_information": [ { "code": "93798", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 379.00, "discounted_cash": 379.00, "minimum": 129.41, "maximum": 136.22, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 136.22, "count": "1 through 10", "median_amount": 169.50, "10th_percentile": 169.50, "90th_percentile": 169.50, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 129.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 136.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Extracranial bilat study", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 802.00, "discounted_cash": 802.00, "minimum": 248.44, "maximum": 261.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 261.51, "count": "1 through 10", "median_amount": 358.81, "10th_percentile": 358.81, "90th_percentile": 358.81, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us carotid duplex bilateral", "code_information": [ { "code": "93880", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 802.00, "discounted_cash": 802.00, "minimum": 248.44, "maximum": 261.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 261.51, "count": "1 through 10", "median_amount": 358.81, "10th_percentile": 358.81, "90th_percentile": 358.81, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Extremity study", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 802.00, "discounted_cash": 802.00, "minimum": 248.44, "maximum": 261.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 261.51, "count": "1 through 10", "median_amount": 358.81, "10th_percentile": 358.81, "90th_percentile": 358.81, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us lower ext venous duplex bilateral", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 802.00, "discounted_cash": 802.00, "minimum": 248.44, "maximum": 261.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 261.51, "count": "1 through 10", "median_amount": 358.81, "10th_percentile": 358.81, "90th_percentile": 358.81, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 248.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 261.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Extremity study", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 386.00, "discounted_cash": 386.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us lower ext venous duplex left", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 386.00, "discounted_cash": 386.00, "minimum": 109.30, "maximum": 115.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 109.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 115.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "94010 spirometry w/ graphic record total/timed vital capacity expiratory flow rate measurement(s)", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 499.00, "discounted_cash": 499.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "12", "median_amount": 30.88, "10th_percentile": 7.08, "90th_percentile": 56.87, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Breathing capacity test", "code_information": [ { "code": "94010", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 499.00, "discounted_cash": 499.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "12", "median_amount": 30.88, "10th_percentile": 7.08, "90th_percentile": 56.87, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "94060 bronchodilation responsiveness spirometry as in 94010 pre- and post-bronchodilator administr", "code_information": [ { "code": "94060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 339.00, "discounted_cash": 339.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Evaluation of wheezing", "code_information": [ { "code": "94060", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 339.00, "discounted_cash": 339.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "94640 ed nebulizer ippb device", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 216.00, "minimum": 209.04, "maximum": 220.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 220.05, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 220.05, "count": "1 through 10", "median_amount": 8.97, "10th_percentile": 8.97, "90th_percentile": 8.97, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 220.05, "count": "1 through 10", "median_amount": 14.28, "10th_percentile": 13.91, "90th_percentile": 14.28, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 209.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 209.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 209.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Airway inhalation treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 216.00, "minimum": 209.04, "maximum": 220.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 220.05, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 220.05, "count": "1 through 10", "median_amount": 8.97, "10th_percentile": 8.97, "90th_percentile": 8.97, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 220.05, "count": "1 through 10", "median_amount": 14.28, "10th_percentile": 13.91, "90th_percentile": 14.28, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 209.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 209.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 209.04, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 220.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "94727 gas dilution washout for determining lung volume", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 499.00, "discounted_cash": 499.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pulm function test by gas", "code_information": [ { "code": "94727", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 499.00, "discounted_cash": 499.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Measure blood oxygen level", "code_information": [ { "code": "94762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 477.00, "discounted_cash": 477.00, "minimum": 866.03, "maximum": 911.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rt pulse oximetry single day charge", "code_information": [ { "code": "94762", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 477.00, "discounted_cash": 477.00, "minimum": 866.03, "maximum": 911.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "95808 polysom any age 1-3 param charge", "code_information": [ { "code": "95808", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3129.00, "discounted_cash": 3129.00, "minimum": 1045.67, "maximum": 1100.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polysom any age 1-3> param", "code_information": [ { "code": "95808", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3129.00, "discounted_cash": 3129.00, "minimum": 1045.67, "maximum": 1100.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "95810 polysom 6/> yrs 4 or more param charge", "code_information": [ { "code": "95810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3129.00, "discounted_cash": 3129.00, "minimum": 1045.67, "maximum": 1100.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polysom 6/> yrs 4/> param", "code_information": [ { "code": "95810", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3129.00, "discounted_cash": 3129.00, "minimum": 1045.67, "maximum": 1100.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "95811 attend split night sleep study w/ interp", "code_information": [ { "code": "95811", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3129.00, "discounted_cash": 3129.00, "minimum": 1045.67, "maximum": 1100.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1100.71, "count": "1 through 10", "median_amount": 1358.87, "10th_percentile": 1326.53, "90th_percentile": 1391.21, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Polysom 6/>yrs cpap 4/> parm", "code_information": [ { "code": "95811", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 3129.00, "discounted_cash": 3129.00, "minimum": 1045.67, "maximum": 1100.71, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1100.71, "count": "1 through 10", "median_amount": 1358.87, "10th_percentile": 1326.53, "90th_percentile": 1391.21, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1045.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1100.71, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eeg awake and drowsy", "code_information": [ { "code": "95816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electroencephalogram including recording awake and drowsy 95816", "code_information": [ { "code": "95816", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eeg awake and asleep", "code_information": [ { "code": "95819", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electroencephalogram including recording awake and asleep 95819", "code_information": [ { "code": "95819", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muscle test one limb", "code_information": [ { "code": "95860", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 388.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography 95860", "code_information": [ { "code": "95860", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 388.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muscle test 2 limbs", "code_information": [ { "code": "95861", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 388.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography 2 extremities with or without related paraspinal areas 95861", "code_information": [ { "code": "95861", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 388.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muscle test 3 limbs", "code_information": [ { "code": "95863", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography 3 extremities with or without related paraspinal areas 95863", "code_information": [ { "code": "95863", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "4 extremities with or without related paraspinal areas 95864", "code_information": [ { "code": "95864", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muscle test 4 limbs", "code_information": [ { "code": "95864", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muscle test cran nerv unilat", "code_information": [ { "code": "95867", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography cranial nerve supplied muscle(s) unilateral 95867", "code_information": [ { "code": "95867", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muscle test cran nerve bilat", "code_information": [ { "code": "95868", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography cranial nerve supplied muscles bilateral 95868", "code_information": [ { "code": "95868", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muscle test thor paraspinal", "code_information": [ { "code": "95869", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography thoracic paraspinal muscles 95869", "code_information": [ { "code": "95869", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muscle test nonparaspinal", "code_information": [ { "code": "95870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 388.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography limited study of muscles in 1 extremity or non-limb muscles other than tho", "code_information": [ { "code": "95870", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 388.00, "discounted_cash": 388.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Muscle test one fiber", "code_information": [ { "code": "95872", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography using single fiber electrode with quantitative measurement of jitter block", "code_information": [ { "code": "95872", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Guide nerv destr needle emg", "code_information": [ { "code": "95874", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 100.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography for guidance in conjunction with chemodenervation 95874", "code_information": [ { "code": "95874", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 100.00, "discounted_cash": 100.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ischemic limb exercise test with serial specimen(s) acquisition for muscle(s) metabolite(s) 95875", "code_information": [ { "code": "95875", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Limb exercise test", "code_information": [ { "code": "95875", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc tst done w/nerv tst lim", "code_information": [ { "code": "95885", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 130.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography each extremity wit related paraspinal areas when performed done with ner", "code_information": [ { "code": "95885", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 130.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc test done w/n test comp", "code_information": [ { "code": "95886", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 288.00, "discounted_cash": 288.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography each extremity wit related paraspinal areas when performed done with ner", "code_information": [ { "code": "95886", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 288.00, "discounted_cash": 288.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Musc tst done w/n tst nonext", "code_information": [ { "code": "95887", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 256.00, "discounted_cash": 256.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Needle electromyography non-extremity muscle(s) done with nerve conduction amplitude and latency/v", "code_information": [ { "code": "95887", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 256.00, "discounted_cash": 256.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nerve conduction studies 1-2 studies 95907", "code_information": [ { "code": "95907", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nvr cndj tst 1-2 studies", "code_information": [ { "code": "95907", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nerve conduction studies 3-4 studies 95908", "code_information": [ { "code": "95908", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj tst 3-4 studies", "code_information": [ { "code": "95908", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nerve conduction studies 5-6 studies 95909", "code_information": [ { "code": "95909", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "1 through 10", "median_amount": 182.96, "10th_percentile": 61.10, "90th_percentile": 304.81, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj tst 5-6 studies", "code_information": [ { "code": "95909", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "1 through 10", "median_amount": 182.96, "10th_percentile": 61.10, "90th_percentile": 304.81, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nerve conduction studies 7-8 studies 95910", "code_information": [ { "code": "95910", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "1 through 10", "median_amount": 395.66, "10th_percentile": 395.66, "90th_percentile": 395.66, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 7-8 studies", "code_information": [ { "code": "95910", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "1 through 10", "median_amount": 395.66, "10th_percentile": 395.66, "90th_percentile": 395.66, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nerve conduction studies 9-10 studies 95911", "code_information": [ { "code": "95911", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1625.00, "discounted_cash": 1625.00, "minimum": 545.35, "maximum": 574.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 574.05, "count": "1 through 10", "median_amount": 435.85, "10th_percentile": 123.23, "90th_percentile": 748.47, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 9-10 studies", "code_information": [ { "code": "95911", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1625.00, "discounted_cash": 1625.00, "minimum": 545.35, "maximum": 574.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 574.05, "count": "1 through 10", "median_amount": 435.85, "10th_percentile": 123.23, "90th_percentile": 748.47, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nerve conduction studies 11-12 studies 95912", "code_information": [ { "code": "95912", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1625.00, "discounted_cash": 1625.00, "minimum": 545.35, "maximum": 574.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 11-12 studies", "code_information": [ { "code": "95912", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1625.00, "discounted_cash": 1625.00, "minimum": 545.35, "maximum": 574.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nerve conduction studies 13 or more studies 95913", "code_information": [ { "code": "95913", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1625.00, "discounted_cash": 1625.00, "minimum": 545.35, "maximum": 574.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nrv cndj test 13/> studies", "code_information": [ { "code": "95913", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1625.00, "discounted_cash": 1625.00, "minimum": 545.35, "maximum": 574.05, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 545.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 574.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Short-latency somatosensory evoked potential study stiumlation of any/all peripheral nerves or skin", "code_information": [ { "code": "95925", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Somatosensory testing", "code_information": [ { "code": "95925", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Short-latency somatosensory evoked potential study stiumlation of any/all peripheral nerves or skin", "code_information": [ { "code": "95926", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Somatosensory testing", "code_information": [ { "code": "95926", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Short-latency somatosensory evoked potential study simulation of any/all peripheral nerves or skin", "code_information": [ { "code": "95927", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Somatosensory testing", "code_information": [ { "code": "95927", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Visual ep test cns w/i&r", "code_information": [ { "code": "95930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Visual evoked potential testing central nervous system checkerboard or flash 95930", "code_information": [ { "code": "95930", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 953.00, "discounted_cash": 953.00, "minimum": 320.06, "maximum": 336.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 320.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 336.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neuromuscular junction test", "code_information": [ { "code": "95937", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neuromuscular junction testing each nerve any 1 method 95937", "code_information": [ { "code": "95937", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 474.00, "discounted_cash": 474.00, "minimum": 160.81, "maximum": 169.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 160.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 169.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "95992 ot canalith repositioning charge", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.00, "discounted_cash": 135.00, "minimum": 33.05, "maximum": 34.79, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 33.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 33.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 33.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Canalith repositioning proc", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 135.00, "discounted_cash": 135.00, "minimum": 33.05, "maximum": 34.79, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 33.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 33.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 33.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 34.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96125 slp standard cog performance test charge", "code_information": [ { "code": "96125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 375.00, "discounted_cash": 375.00, "minimum": 96.97, "maximum": 102.07, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 96.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 96.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 96.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cognitive test by hc pro", "code_information": [ { "code": "96125", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 375.00, "discounted_cash": 375.00, "minimum": 96.97, "maximum": 102.07, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 96.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 96.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 96.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 102.07, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96360 hydration first hour", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 658.00, "discounted_cash": 658.00, "minimum": 216.55, "maximum": 227.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 227.94, "count": "1 through 10", "median_amount": 297.31, "10th_percentile": 44.68, "90th_percentile": 450.47, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydration iv infusion init", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 658.00, "discounted_cash": 658.00, "minimum": 216.55, "maximum": 227.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 227.94, "count": "1 through 10", "median_amount": 297.31, "10th_percentile": 44.68, "90th_percentile": 450.47, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96361 hydration each additional hour", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 185.00, "minimum": 47.42, "maximum": 49.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 165.82, "10th_percentile": 99.49, "90th_percentile": 165.82, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrate iv infusion add-on", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 185.00, "discounted_cash": 185.00, "minimum": 47.42, "maximum": 49.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 165.82, "10th_percentile": 99.49, "90th_percentile": 165.82, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96365 iv infusion 1st hour charge", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 654.00, "discounted_cash": 654.00, "minimum": 216.55, "maximum": 227.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 227.94, "count": "25", "median_amount": 50.56, "10th_percentile": 50.56, "90th_percentile": 345.56, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 227.94, "count": "1 through 10", "median_amount": 333.55, "10th_percentile": 323.60, "90th_percentile": 333.55, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 227.94, "count": "90", "median_amount": 292.48, "10th_percentile": 82.47, "90th_percentile": 370.00, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "1 through 10", "median_amount": 331.59, "10th_percentile": 327.61, "90th_percentile": 335.56, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther/proph/diag iv inf init", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 654.00, "discounted_cash": 654.00, "minimum": 216.55, "maximum": 227.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 227.94, "count": "25", "median_amount": 50.56, "10th_percentile": 50.56, "90th_percentile": 345.56, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 227.94, "count": "1 through 10", "median_amount": 333.55, "10th_percentile": 323.60, "90th_percentile": 333.55, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 227.94, "count": "90", "median_amount": 292.48, "10th_percentile": 82.47, "90th_percentile": 370.00, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "1 through 10", "median_amount": 331.59, "10th_percentile": 327.61, "90th_percentile": 335.56, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96366 iv infusion ea add'l hr", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 202.00, "discounted_cash": 202.00, "minimum": 47.42, "maximum": 49.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 90.28, "10th_percentile": 89.13, "90th_percentile": 207.64, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther/proph/diag iv inf addon", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 202.00, "discounted_cash": 202.00, "minimum": 47.42, "maximum": 49.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 90.28, "10th_percentile": 89.13, "90th_percentile": 207.64, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96367 iv infusion add'l sequential up to 1hr charge", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 170.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx/proph/dg addl seq iv inf", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 170.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96368 iv infusion concurrent charge", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 74.00, "discounted_cash": 74.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther/diag concurrent inf", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 74.00, "discounted_cash": 74.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96372 im/subq injection", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "1 through 10", "median_amount": 22.32, "10th_percentile": 22.32, "90th_percentile": 22.32, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "32", "median_amount": 12.90, "10th_percentile": 11.38, "90th_percentile": 178.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "1 through 10", "median_amount": 11.94, "10th_percentile": 11.94, "90th_percentile": 11.94, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "1 through 10", "median_amount": 11.94, "10th_percentile": 11.94, "90th_percentile": 11.94, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther/proph/diag inj sc/im", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "1 through 10", "median_amount": 22.32, "10th_percentile": 22.32, "90th_percentile": 22.32, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "32", "median_amount": 12.90, "10th_percentile": 11.38, "90th_percentile": 178.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "1 through 10", "median_amount": 11.94, "10th_percentile": 11.94, "90th_percentile": 11.94, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "1 through 10", "median_amount": 11.94, "10th_percentile": 11.94, "90th_percentile": 11.94, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96374 iv injection single/initial", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 654.00, "discounted_cash": 654.00, "minimum": 216.55, "maximum": 227.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 227.94, "count": "1 through 10", "median_amount": 328.76, "10th_percentile": 328.76, "90th_percentile": 328.76, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 227.94, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 227.94, "count": "1 through 10", "median_amount": 301.23, "10th_percentile": 110.00, "90th_percentile": 301.23, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther/proph/diag inj iv push", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 654.00, "discounted_cash": 654.00, "minimum": 216.55, "maximum": 227.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 227.94, "count": "1 through 10", "median_amount": 328.76, "10th_percentile": 328.76, "90th_percentile": 328.76, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 227.94, "standard_charge_percentage": 75.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 227.94, "count": "1 through 10", "median_amount": 301.23, "10th_percentile": 110.00, "90th_percentile": 301.23, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 216.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 227.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96375 iv injection add new drug", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 156.00, "discounted_cash": 156.00, "minimum": 47.42, "maximum": 49.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 80.03, "10th_percentile": 80.03, "90th_percentile": 80.03, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 69.55, "10th_percentile": 69.55, "90th_percentile": 69.55, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 165.36, "10th_percentile": 165.36, "90th_percentile": 165.36, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx/pro/dx inj new drug addon", "code_information": [ { "code": "96375", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 156.00, "discounted_cash": 156.00, "minimum": 47.42, "maximum": 49.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 80.03, "10th_percentile": 80.03, "90th_percentile": 80.03, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 69.55, "10th_percentile": 69.55, "90th_percentile": 69.55, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 165.36, "10th_percentile": 165.36, "90th_percentile": 165.36, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96376 iv injection add same drug", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 137.00, "discounted_cash": 137.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tx/pro/dx inj same drug adon", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 137.00, "discounted_cash": 137.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96401 chemotherapy administration subcutaneous or intramuscular; non-hormonal anti-neoplastic", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 227.00, "discounted_cash": 227.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo anti-neopl sq/im", "code_information": [ { "code": "96401", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 227.00, "discounted_cash": 227.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96413 chemo iv infusion initial up to 1hr charge", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1033.00, "discounted_cash": 1033.00, "minimum": 340.91, "maximum": 358.85, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo iv infusion 1 hr", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1033.00, "discounted_cash": 1033.00, "minimum": 340.91, "maximum": 358.85, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 340.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 358.85, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96415 chemo iv infusion ea add'l hr charge", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 214.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo iv infusion addl hr", "code_information": [ { "code": "96415", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 214.00, "discounted_cash": 214.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96417 chemotherapy administration intravenous infusion technique; each additional sequential infusi", "code_information": [ { "code": "96417", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 227.00, "discounted_cash": 227.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chemo iv infus each addl seq", "code_information": [ { "code": "96417", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 227.00, "discounted_cash": 227.00, "minimum": 73.15, "maximum": 77.00, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 73.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 77.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "96523 port flush.", "code_information": [ { "code": "96523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Irrig drug delivery device", "code_information": [ { "code": "96523", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 190.00, "discounted_cash": 190.00, "minimum": 61.05, "maximum": 64.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 61.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 64.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mechanical traction therapy", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 61.00, "minimum": 13.82, "maximum": 14.55, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt mechanical traction units", "code_information": [ { "code": "97012", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 61.00, "discounted_cash": 61.00, "minimum": 13.82, "maximum": 14.55, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt vasopneumatic devices units", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79.00, "discounted_cash": 79.00, "minimum": 11.33, "maximum": 11.93, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 11.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 11.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 11.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vasopneumatic device therapy", "code_information": [ { "code": "97016", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 79.00, "discounted_cash": 79.00, "minimum": 11.33, "maximum": 11.93, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 11.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 11.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 11.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 11.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Paraffin bath therapy", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 41.00, "minimum": 5.99, "maximum": 6.31, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt paraffin units", "code_information": [ { "code": "97018", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 41.00, "discounted_cash": 41.00, "minimum": 5.99, "maximum": 6.31, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 5.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 5.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 5.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt whirlpool fluidotherapy units", "code_information": [ { "code": "97022", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 74.00, "discounted_cash": 74.00, "minimum": 15.23, "maximum": 16.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 15.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 15.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 15.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Whirlpool therapy", "code_information": [ { "code": "97022", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 74.00, "discounted_cash": 74.00, "minimum": 15.23, "maximum": 16.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 15.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 15.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 15.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 16.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electrical stimulation", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 45.00, "minimum": 13.82, "maximum": 14.55, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt attended e-stim assistant units", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 45.00, "discounted_cash": 45.00, "minimum": 13.82, "maximum": 14.55, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 14.55, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Electric current therapy", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 110.00, "minimum": 18.34, "maximum": 19.30, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 18.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 18.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 18.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot iontophoresis units", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 110.00, "minimum": 18.34, "maximum": 19.30, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 18.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 18.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 18.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 19.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt ultrasound assistant units", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 60.00, "minimum": 13.56, "maximum": 14.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ultrasound therapy", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 60.00, "minimum": 13.56, "maximum": 14.27, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 13.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 13.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 13.56, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 14.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot therapeutic exercise units", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 110.00, "minimum": 28.11, "maximum": 29.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Therapeutic exercises", "code_information": [ { "code": "97110", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 110.00, "minimum": 28.11, "maximum": 29.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neuromuscular reeducation", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 127.00, "discounted_cash": 127.00, "minimum": 31.27, "maximum": 32.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 31.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 31.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 31.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot neuromuscular reeducation units", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 127.00, "discounted_cash": 127.00, "minimum": 31.27, "maximum": 32.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 31.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 31.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 31.27, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 32.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gait training charges", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 105.00, "discounted_cash": 105.00, "minimum": 28.11, "maximum": 29.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gait training therapy", "code_information": [ { "code": "97116", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 105.00, "discounted_cash": 105.00, "minimum": 28.11, "maximum": 29.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 28.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 29.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot cog ther interventfirst 15 min units", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 80.00, "minimum": 20.60, "maximum": 21.68, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 20.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 20.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 20.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther ivntj 1st 15 min", "code_information": [ { "code": "97129", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 80.00, "minimum": 20.60, "maximum": 21.68, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 20.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 20.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 20.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 21.68, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot cog ther intervent addl 15 min units", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 77.00, "discounted_cash": 77.00, "minimum": 19.98, "maximum": 21.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ther ivntj ea addl 15 min", "code_information": [ { "code": "97130", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 77.00, "discounted_cash": 77.00, "minimum": 19.98, "maximum": 21.03, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 21.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Manual therapy 1/> regions", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 115.00, "minimum": 26.51, "maximum": 27.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 26.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 26.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 26.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot manual therapy units", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 115.00, "discounted_cash": 115.00, "minimum": 26.51, "maximum": 27.91, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 26.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 26.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 26.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 27.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt eval low complex 20 min", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 219.00, "discounted_cash": 219.00, "minimum": 95.64, "maximum": 100.67, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt evaluation units low complexity", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 219.00, "discounted_cash": 219.00, "minimum": 95.64, "maximum": 100.67, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt eval mod complex 30 min", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 232.00, "discounted_cash": 232.00, "minimum": 95.64, "maximum": 100.67, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt evaluation units moderate complexity", "code_information": [ { "code": "97162", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 232.00, "discounted_cash": 232.00, "minimum": 95.64, "maximum": 100.67, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt eval high complex 45 min", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.00, "discounted_cash": 243.00, "minimum": 95.64, "maximum": 100.67, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt evaluation units high complexity", "code_information": [ { "code": "97163", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 243.00, "discounted_cash": 243.00, "minimum": 95.64, "maximum": 100.67, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 95.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 100.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt re-eval est plan care", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 130.00, "minimum": 66.16, "maximum": 69.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 66.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 66.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 66.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt re-evaluation units 97164", "code_information": [ { "code": "97164", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 130.00, "discounted_cash": 130.00, "minimum": 66.16, "maximum": 69.64, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 66.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 66.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 66.16, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 69.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot eval low complex 30 min", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 327.00, "discounted_cash": 327.00, "minimum": 98.23, "maximum": 103.40, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot evaluation units low complexity", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 327.00, "discounted_cash": 327.00, "minimum": 98.23, "maximum": 103.40, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot eval mod complex 45 min", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.00, "discounted_cash": 324.00, "minimum": 98.23, "maximum": 103.40, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot evaluation units moderate complexity", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.00, "discounted_cash": 324.00, "minimum": 98.23, "maximum": 103.40, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot eval high complex 60 min", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.00, "discounted_cash": 324.00, "minimum": 98.23, "maximum": 103.40, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot evaluation units high complexity", "code_information": [ { "code": "97167", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 324.00, "discounted_cash": 324.00, "minimum": 98.23, "maximum": 103.40, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 98.23, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 103.40, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot re-eval est plan care", "code_information": [ { "code": "97168", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 226.00, "discounted_cash": 226.00, "minimum": 68.03, "maximum": 71.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 68.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 68.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 68.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot re-evaluation units 97168", "code_information": [ { "code": "97168", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 226.00, "discounted_cash": 226.00, "minimum": 68.03, "maximum": 71.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 68.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 68.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 68.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 71.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot therapeutic activities units", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 141.00, "discounted_cash": 141.00, "minimum": 33.94, "maximum": 35.73, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 33.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 33.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 33.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Therapeutic activities", "code_information": [ { "code": "97530", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 141.00, "discounted_cash": 141.00, "minimum": 33.94, "maximum": 35.73, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 33.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 33.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 33.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 35.73, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot self care home management units", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 124.00, "minimum": 31.34, "maximum": 32.99, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 31.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 31.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 31.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Self care mngment training", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 124.00, "discounted_cash": 124.00, "minimum": 31.34, "maximum": 32.99, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 31.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 31.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 31.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 32.99, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot wheelchair management units", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.00, "discounted_cash": 118.00, "minimum": 30.01, "maximum": 31.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 30.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 30.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 30.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wheelchair mngment training", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 118.00, "discounted_cash": 118.00, "minimum": 30.01, "maximum": 31.59, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 30.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 30.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 30.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 31.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt work hardening initial 2 hours units", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 407.00, "discounted_cash": 407.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Work hardening", "code_information": [ { "code": "97545", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 407.00, "discounted_cash": 407.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pt work hardening-each addl hour units", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 133.00, "discounted_cash": 133.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Work hardening add-on", "code_information": [ { "code": "97546", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 133.00, "discounted_cash": 133.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "97597  debridement open wound 20 sq cm/< techfee", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rmvl devital tis 20 cm/<", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 602.00, "discounted_cash": 602.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "97602 removal devitalized tissue from wound(s) nonselective debidement wo anes", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 632.00, "discounted_cash": 632.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Wound(s) care non-selective", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 632.00, "discounted_cash": 632.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "97606 negative pressure wound therapy; total wound(s) surface area less than or equal to 50 sq cm", "code_information": [ { "code": "97605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 632.00, "discounted_cash": 632.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neg press wound tx <=50 cm", "code_information": [ { "code": "97605", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 632.00, "discounted_cash": 632.00, "minimum": 204.22, "maximum": 214.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 204.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 214.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "97606 negative pressure wound therapy total wound surface greater than 50sq cm", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1272.00, "discounted_cash": 1272.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Neg press wound tx >50 cm", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1272.00, "discounted_cash": 1272.00, "minimum": 410.64, "maximum": 432.25, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 410.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 432.25, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot physical performance test", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 110.00, "minimum": 32.63, "maximum": 34.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 32.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 32.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 32.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Physical performance test", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 110.00, "discounted_cash": 110.00, "minimum": 32.63, "maximum": 34.35, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 32.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 32.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 32.63, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 34.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Orthotic mgmt&traing 1st enc", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 179.00, "discounted_cash": 179.00, "minimum": 45.19, "maximum": 47.57, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 45.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 45.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 45.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot orthotic management train units", "code_information": [ { "code": "97760", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 179.00, "discounted_cash": 179.00, "minimum": 45.19, "maximum": 47.57, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 45.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 45.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 45.19, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 47.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot prosthetic management train units", "code_information": [ { "code": "97761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 112.00, "discounted_cash": 112.00, "minimum": 39.69, "maximum": 41.78, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 39.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 39.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 39.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prosthetic traing 1st enc", "code_information": [ { "code": "97761", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 112.00, "discounted_cash": 112.00, "minimum": 39.69, "maximum": 41.78, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 39.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 39.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 39.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 41.78, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "97763 orthotic/prosthetic management subsequent encounter charge", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 191.00, "discounted_cash": 191.00, "minimum": 49.42, "maximum": 52.02, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 49.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 49.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 49.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Orthc/prostc mgmt sbsq enc", "code_information": [ { "code": "97763", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 191.00, "discounted_cash": 191.00, "minimum": 49.42, "maximum": 52.02, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 49.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 49.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 49.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 52.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dot/non dot breath alcohol", "code_information": [ { "code": "99000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 83.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Specimen handling office-lab", "code_information": [ { "code": "99000", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 83.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99024 post-op f/u visit included in the surgical package", "code_information": [ { "code": "99024", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Postop follow-up visit", "code_information": [ { "code": "99024", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 0.01, "discounted_cash": 0.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99151 mod sed same phys/qhp initial 15 mins <5 yrs techfee", "code_information": [ { "code": "99151", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 83.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mod sed same phys/qhp <5 yrs", "code_information": [ { "code": "99151", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 83.00, "discounted_cash": 83.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99152 mod sed same phys/qhp initial 15 mins 5/> yrs techfee", "code_information": [ { "code": "99152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44.00, "discounted_cash": 44.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mod sed same phys/qhp 5/>yrs", "code_information": [ { "code": "99152", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 44.00, "discounted_cash": 44.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99153 mod sedation same phys ea addl 15 min", "code_information": [ { "code": "99153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 38.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mod sed same phys/qhp ea", "code_information": [ { "code": "99153", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 38.00, "discounted_cash": 38.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99156 mod sed oth phys/qhp 5/>5yrs techfee", "code_information": [ { "code": "99156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 276.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mod sed oth phys/qhp 5/>yrs", "code_information": [ { "code": "99156", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 276.00, "discounted_cash": 276.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99157 mod sed other phys/qhp ea 15 min techfee", "code_information": [ { "code": "99157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 230.00, "discounted_cash": 230.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mod sed other phys/qhp ea", "code_information": [ { "code": "99157", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 230.00, "discounted_cash": 230.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phlebotomy", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 411.00, "discounted_cash": 411.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "1 through 10", "median_amount": 183.78, "10th_percentile": 183.78, "90th_percentile": 183.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Therapeutic phlebotomy", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 411.00, "discounted_cash": 411.00, "minimum": 132.48, "maximum": 139.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.46, "count": "1 through 10", "median_amount": 183.78, "10th_percentile": 183.78, "90th_percentile": 183.78, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99204 office visit new pt. level 4", "code_information": [ { "code": "99204", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 169.00, "discounted_cash": 169.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office/outpatient visit new", "code_information": [ { "code": "99204", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 169.00, "discounted_cash": 169.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99211 office/outpatient for e&m of est. pt. visit w/ or w/o physician", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Office/outpatient visit est", "code_information": [ { "code": "99211", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 12.00, "discounted_cash": 12.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Subsequent hospital care", "code_information": [ { "code": "99232", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5894.50, "discounted_cash": 5894.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hospital discharge day", "code_information": [ { "code": "99239", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 5894.50, "discounted_cash": 5894.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99281 - level 1", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 240.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 240.00, "discounted_cash": 240.00, "minimum": 90.50, "maximum": 95.26, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 90.50, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 95.26, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99282 - level 2", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 427.00, "discounted_cash": 427.00, "minimum": 162.76, "maximum": 171.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 171.33, "count": "1 through 10", "median_amount": 191.15, "10th_percentile": 191.15, "90th_percentile": 191.15, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "1 through 10", "median_amount": 109.95, "10th_percentile": 109.95, "90th_percentile": 109.95, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99282", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 427.00, "discounted_cash": 427.00, "minimum": 162.76, "maximum": 171.33, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 171.33, "count": "1 through 10", "median_amount": 191.15, "10th_percentile": 191.15, "90th_percentile": 191.15, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 162.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 162.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 162.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 171.33, "count": "1 through 10", "median_amount": 109.95, "10th_percentile": 109.95, "90th_percentile": 109.95, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 171.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99283 - level 3", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 760.00, "discounted_cash": 760.00, "minimum": 284.59, "maximum": 299.57, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 299.57, "count": "1 through 10", "median_amount": 266.14, "10th_percentile": 266.14, "90th_percentile": 266.14, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 299.57, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 299.57, "count": "1 through 10", "median_amount": 371.62, "10th_percentile": 371.62, "90th_percentile": 371.62, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 299.57, "count": "14", "median_amount": 339.92, "10th_percentile": 246.61, "90th_percentile": 347.02, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 284.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 284.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 284.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99283", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 760.00, "discounted_cash": 760.00, "minimum": 284.59, "maximum": 299.57, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 299.57, "count": "1 through 10", "median_amount": 266.14, "10th_percentile": 266.14, "90th_percentile": 266.14, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 299.57, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 299.57, "count": "1 through 10", "median_amount": 371.62, "10th_percentile": 371.62, "90th_percentile": 371.62, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 299.57, "count": "14", "median_amount": 339.92, "10th_percentile": 246.61, "90th_percentile": 347.02, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 284.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 284.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 284.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 299.57, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99284 - level 4", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1283.00, "discounted_cash": 1283.00, "minimum": 437.66, "maximum": 460.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 460.69, "count": "1 through 10", "median_amount": 729.72, "10th_percentile": 729.72, "90th_percentile": 729.72, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 460.69, "count": "1 through 10", "median_amount": 561.70, "10th_percentile": 538.07, "90th_percentile": 578.54, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 437.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 437.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 437.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99284", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1283.00, "discounted_cash": 1283.00, "minimum": 437.66, "maximum": 460.69, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 460.69, "count": "1 through 10", "median_amount": 729.72, "10th_percentile": 729.72, "90th_percentile": 729.72, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 460.69, "count": "1 through 10", "median_amount": 561.70, "10th_percentile": 538.07, "90th_percentile": 578.54, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 437.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 437.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 437.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 460.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99285 - level 5", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2329.00, "discounted_cash": 2329.00, "minimum": 630.14, "maximum": 663.31, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 663.31, "count": "1 through 10", "median_amount": 997.10, "10th_percentile": 997.10, "90th_percentile": 997.10, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Emergency dept visit", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2329.00, "discounted_cash": 2329.00, "minimum": 630.14, "maximum": 663.31, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 663.31, "count": "1 through 10", "median_amount": 997.10, "10th_percentile": 997.10, "90th_percentile": 997.10, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99291 - critical care 30-74", "code_information": [ { "code": "99291", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2295.00, "discounted_cash": 2295.00, "minimum": 866.03, "maximum": 911.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 911.61, "count": "1 through 10", "median_amount": 162.18, "10th_percentile": 162.18, "90th_percentile": 162.18, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Critical care first hour", "code_information": [ { "code": "99291", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 2295.00, "discounted_cash": 2295.00, "minimum": 866.03, "maximum": 911.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 911.61, "count": "1 through 10", "median_amount": 162.18, "10th_percentile": 162.18, "90th_percentile": 162.18, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 866.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 911.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99292 - critical care addl 30 min", "code_information": [ { "code": "99292", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1200.00, "discounted_cash": 1200.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Critical care addl 30 min", "code_information": [ { "code": "99292", "type": "CPT" } ], "standard_charges": [ { "gross_charge": 1200.00, "discounted_cash": 1200.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ambulance mileage", "code_information": [ { "code": "A0425", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 20.00, "minimum": 8.52, "maximum": 8.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 8.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 8.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 8.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ground mileage", "code_information": [ { "code": "A0425", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 20.00, "discounted_cash": 20.00, "minimum": 8.52, "maximum": 8.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 8.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 8.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 8.52, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 8.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Als 1", "code_information": [ { "code": "A0426", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1086.00, "discounted_cash": 1086.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Als level 1 non-emergency", "code_information": [ { "code": "A0426", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1086.00, "discounted_cash": 1086.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Als level 1 emergency", "code_information": [ { "code": "A0427", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1446.00, "discounted_cash": 1446.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Als1-emergency", "code_information": [ { "code": "A0427", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1446.00, "discounted_cash": 1446.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bls", "code_information": [ { "code": "A0428", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 597.00, "discounted_cash": 597.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bls non-emergency", "code_information": [ { "code": "A0428", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 597.00, "discounted_cash": 597.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bls emergency", "code_information": [ { "code": "A0429", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 905.00, "discounted_cash": 905.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bls-emergency", "code_information": [ { "code": "A0429", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 905.00, "discounted_cash": 905.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Als paramedic intercept", "code_information": [ { "code": "A0432", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1446.00, "discounted_cash": 1446.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pi volunteer ambulance co", "code_information": [ { "code": "A0432", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1446.00, "discounted_cash": 1446.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Als 2", "code_information": [ { "code": "A0433", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1808.00, "discounted_cash": 1808.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Als level 2 emergency or non-emergency", "code_information": [ { "code": "A0433", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1808.00, "discounted_cash": 1808.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Speciality care transport", "code_information": [ { "code": "A0434", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2410.00, "discounted_cash": 2410.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Specialty care transport", "code_information": [ { "code": "A0434", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2410.00, "discounted_cash": 2410.00, "minimum": 265.03, "maximum": 278.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 265.03, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 278.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Coolief avanos mcka2-17-150-4", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1946.70, "discounted_cash": 1946.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Surgical supplies", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1946.70, "discounted_cash": 1946.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Foam drg >16<=48 sq in w/o b", "code_information": [ { "code": "A6210", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 34.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrofera blue 4x5", "code_information": [ { "code": "A6210", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 34.00, "discounted_cash": 34.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lchn tc99m sestamibi", "code_information": [ { "code": "A9500", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1076.00, "discounted_cash": 1076.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m sestamibi", "code_information": [ { "code": "A9500", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1076.00, "discounted_cash": 1076.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lchn tc99m medrofenin", "code_information": [ { "code": "A9537", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 970.00, "discounted_cash": 970.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tc99m mebrofenin", "code_information": [ { "code": "A9537", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 970.00, "discounted_cash": 970.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gad-base mr contrast nos1ml", "code_information": [ { "code": "A9579", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 784.00, "discounted_cash": 784.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lchn gadolinium based mri agent per ml", "code_information": [ { "code": "A9579", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 784.00, "discounted_cash": 784.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 50% iv sol 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "B4164", "type": "HCPCS" }, { "code": "76329EA3301EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 39.75, "discounted_cash": 39.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 50% iv sol 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "B4164", "type": "HCPCS" }, { "code": "76329EA3302EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.28, "discounted_cash": 50.28, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dextrose 50% iv sol 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "B4164", "type": "HCPCS" }, { "code": "00409EA4902EA34", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.15, "discounted_cash": 34.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Anchor/screw bn/bntis/bn", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 4899.00, "discounted_cash": 4899.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pinn sector w/gription 58mm", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 4899.00, "discounted_cash": 4899.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cath drainage", "code_information": [ { "code": "C1729", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Chest tube 10fr", "code_information": [ { "code": "C1729", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 39.00, "discounted_cash": 39.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cath inf per/cent/midline", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 317.41, "discounted_cash": 317.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Power picc", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 317.41, "discounted_cash": 317.41, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Attune crs fb base", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 15891.00, "discounted_cash": 15891.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Joint device (implantable)", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 15891.00, "discounted_cash": 15891.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acrysof iol sn60wf", "code_information": [ { "code": "C1780", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 318.00, "discounted_cash": 318.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lens intraocular (new tech)", "code_information": [ { "code": "C1780", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 318.00, "discounted_cash": 318.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mesh (implantable)", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2541.44, "discounted_cash": 2541.44, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ventrio st medium oval", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2541.44, "discounted_cash": 2541.44, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Istent", "code_information": [ { "code": "C1783", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 6259.00, "discounted_cash": 6259.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ocular imp aqueous drain de", "code_information": [ { "code": "C1783", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 6259.00, "discounted_cash": 6259.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Port indwelling imp", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 999.30, "discounted_cash": 999.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Power port", "code_information": [ { "code": "C1788", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 999.30, "discounted_cash": 999.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Steris max pure filter", "code_information": [ { "code": "C1880", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 525.00, "discounted_cash": 525.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vena cava filter", "code_information": [ { "code": "C1880", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 525.00, "discounted_cash": 525.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Catheter ablation", "code_information": [ { "code": "C1886", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1946.70, "discounted_cash": 1946.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Coolief avanos mcka2-17-100-4", "code_information": [ { "code": "C1886", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1946.70, "discounted_cash": 1946.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra chest w/o contrast", "code_information": [ { "code": "C8910", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3014.00, "discounted_cash": 3014.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra w/o cont chest", "code_information": [ { "code": "C8910", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3014.00, "discounted_cash": 3014.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra pelvis w/o contrast", "code_information": [ { "code": "C8919", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3615.00, "discounted_cash": 3615.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Mra w/o cont pelvis", "code_information": [ { "code": "C8919", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 3615.00, "discounted_cash": 3615.00, "minimum": 555.29, "maximum": 584.51, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 555.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 584.51, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tte w or wo fol wcondoppler", "code_information": [ { "code": "C8929", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2268.00, "discounted_cash": 2268.00, "minimum": 812.02, "maximum": 854.76, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 812.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 812.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 812.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Us echocardiogram complete w/ contrast", "code_information": [ { "code": "C8929", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 2268.00, "discounted_cash": 2268.00, "minimum": 812.02, "maximum": 854.76, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 812.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 812.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 812.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 854.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Integra meshed bil wound mat", "code_information": [ { "code": "C9363", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 9259.22, "discounted_cash": 9259.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Integra meshed bilayer wound matrix 2inx2in", "code_information": [ { "code": "C9363", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 9259.22, "discounted_cash": 9259.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "90471 immunization administration < 19 yrs - amb immun admin charge", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "minimum": 47.42, "maximum": 49.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 33.74, "10th_percentile": 33.74, "90th_percentile": 33.74, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 42.68, "10th_percentile": 29.62, "90th_percentile": 42.81, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 49.92, "count": "119", "median_amount": 42.68, "10th_percentile": 42.42, "90th_percentile": 42.68, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 33.74, "10th_percentile": 33.74, "90th_percentile": 33.74, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "25", "median_amount": 33.74, "10th_percentile": 33.74, "90th_percentile": 33.74, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Admin influenza virus vac", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 208.00, "discounted_cash": 208.00, "minimum": 47.42, "maximum": 49.92, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 33.74, "10th_percentile": 33.74, "90th_percentile": 33.74, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 42.68, "10th_percentile": 29.62, "90th_percentile": 42.81, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 49.92, "count": "119", "median_amount": 42.68, "10th_percentile": 42.42, "90th_percentile": 42.68, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 47.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 49.92, "count": "1 through 10", "median_amount": 33.74, "10th_percentile": 33.74, "90th_percentile": 33.74, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 49.92, "count": "25", "median_amount": 33.74, "10th_percentile": 33.74, "90th_percentile": 33.74, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 49.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Psa screening", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 182.00, "discounted_cash": 182.00, "minimum": 18.34, "maximum": 19.31, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 19.31, "count": "1 through 10", "median_amount": 93.81, "10th_percentile": 93.81, "90th_percentile": 93.81, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.31, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 19.31, "count": "1 through 10", "median_amount": 116.13, "10th_percentile": 113.43, "90th_percentile": 118.82, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 19.31, "count": "24", "median_amount": 116.22, "10th_percentile": 113.79, "90th_percentile": 119.50, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 18.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 18.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 18.34, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 19.31, "count": "1 through 10", "median_amount": 93.81, "10th_percentile": 93.81, "90th_percentile": 110.69, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 19.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colorectal scrn; hi risk ind", "code_information": [ { "code": "G0105", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 8067.67, "discounted_cash": 8067.67, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Colon ca scrn not hi rsk ind", "code_information": [ { "code": "G0121", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 6428.14, "discounted_cash": 6428.14, "minimum": 937.05, "maximum": 986.37, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 986.37, "count": "1 through 10", "median_amount": 953.67, "10th_percentile": 162.75, "90th_percentile": 1744.59, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 986.37, "count": "14", "median_amount": 947.89, "10th_percentile": 187.16, "90th_percentile": 1744.59, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 937.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 986.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Elec stim other than wound", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 96.00, "minimum": 11.98, "maximum": 12.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 11.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 11.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 11.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot electrical stim (unattended) - non-wound", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 96.00, "discounted_cash": 96.00, "minimum": 11.98, "maximum": 12.61, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 11.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 11.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 11.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 12.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hospital observation per hr", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 105.00, "discounted_cash": 105.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Room/bed: observation", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 105.00, "discounted_cash": 105.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Direct refer hospital observ", "code_information": [ { "code": "G0379", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1792.00, "discounted_cash": 1792.00, "minimum": 630.14, "maximum": 663.31, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 663.31, "count": "1 through 10", "median_amount": 810.84, "10th_percentile": 810.84, "90th_percentile": 810.84, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Direct to obs charge", "code_information": [ { "code": "G0379", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1792.00, "discounted_cash": 1792.00, "minimum": 630.14, "maximum": 663.31, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 663.31, "count": "1 through 10", "median_amount": 810.84, "10th_percentile": 810.84, "90th_percentile": 810.84, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 630.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 663.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Partial trauma team activation. tech fee", "code_information": [ { "code": "G0390", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1810.00, "discounted_cash": 1810.00, "minimum": 1359.95, "maximum": 1431.53, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1359.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1359.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1359.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Trauma respons w/hosp criti", "code_information": [ { "code": "G0390", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1810.00, "discounted_cash": 1810.00, "minimum": 1359.95, "maximum": 1431.53, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1359.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1359.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1359.95, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1431.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "G0416 prostate biopsy any method", "code_information": [ { "code": "G0416", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 734.00, "discounted_cash": 734.00, "minimum": 369.72, "maximum": 389.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prostate biopsy any mthd", "code_information": [ { "code": "G0416", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 734.00, "discounted_cash": 734.00, "minimum": 369.72, "maximum": 389.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 369.72, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 389.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "99204 office visit new pt. level 4", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 169.00, "discounted_cash": 169.00, "minimum": 132.45, "maximum": 139.42, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.42, "count": "18", "median_amount": 52.50, "10th_percentile": 4.20, "90th_percentile": 79.50, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.42, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.42, "count": "56", "median_amount": 92.36, "10th_percentile": 42.04, "90th_percentile": 101.77, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.42, "count": "731", "median_amount": 30.86, "10th_percentile": 16.12, "90th_percentile": 71.39, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.42, "count": "1 through 10", "median_amount": 69.09, "10th_percentile": 69.09, "90th_percentile": 69.09, "methodology": "fee schedule" }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.42, "count": "14", "median_amount": 51.69, "10th_percentile": 34.45, "90th_percentile": 71.40, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.42, "count": "161", "median_amount": 52.50, "10th_percentile": 22.75, "90th_percentile": 79.50, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hospital outpt clinic visit", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 169.00, "discounted_cash": 169.00, "minimum": 132.45, "maximum": 139.42, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 139.42, "count": "18", "median_amount": 52.50, "10th_percentile": 4.20, "90th_percentile": 79.50, "methodology": "fee schedule" }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.42, "standard_charge_percentage": 61.0, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 139.42, "count": "56", "median_amount": 92.36, "10th_percentile": 42.04, "90th_percentile": 101.77, "methodology": "fee schedule" }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 139.42, "count": "731", "median_amount": 30.86, "10th_percentile": 16.12, "90th_percentile": 71.39, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 139.42, "count": "1 through 10", "median_amount": 69.09, "10th_percentile": 69.09, "90th_percentile": 69.09, "methodology": "fee schedule" }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 132.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 132.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 132.45, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 139.42, "count": "14", "median_amount": 51.69, "10th_percentile": 34.45, "90th_percentile": 71.40, "methodology": "fee schedule" }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 139.42, "count": "161", "median_amount": 52.50, "10th_percentile": 22.75, "90th_percentile": 79.50, "methodology": "fee schedule" }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 139.42, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetaminophen level", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 394.00, "discounted_cash": 394.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug test def 1-7 classes", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 394.00, "discounted_cash": 394.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug screen urine", "code_information": [ { "code": "G0481", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 236.00, "discounted_cash": 236.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drug test def 8-14 classes", "code_information": [ { "code": "G0481", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 236.00, "discounted_cash": 236.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Abatacept 250 mg powder [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0129", "type": "HCPCS" }, { "code": "00003EA2187EA13", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2649.41, "discounted_cash": 2649.41, "minimum": 41.61, "maximum": 43.80, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 41.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 41.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 41.61, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 43.80, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetaminophen 1000 mg/100 ml iv sol [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "J0131", "type": "HCPCS" }, { "code": "24201EA0100EA24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 85.27, "discounted_cash": 85.27, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetaminophen 1000 mg/100 ml iv sol [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "J0131", "type": "HCPCS" }, { "code": "55150EA0307EA24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 60.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetaminophen 1000 mg/100 ml iv sol [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "J0131", "type": "HCPCS" }, { "code": "63323EA0434EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 36.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Acetylcysteine 200 mg/ml iv sol 30 ml [lchn]", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "J0132", "type": "HCPCS" }, { "code": "63323EA0963EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 406.08, "discounted_cash": 406.08, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ampicillin 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0290", "type": "HCPCS" }, { "code": "00781EA9261EA95", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.65, "discounted_cash": 21.65, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", 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"plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ampicillin 2 g", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0290", "type": "HCPCS" }, { "code": "00781EA9273EA95", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 42.00, "discounted_cash": 42.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ampicillineasulbactam 2 gea1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0295", "type": "HCPCS" }, { "code": "00049EA0014EA83", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43.69, "discounted_cash": 43.69, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit 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"0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ampicillineasulbactam 2 gea1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0295", "type": "HCPCS" }, { "code": "55150EA0117EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.50, "discounted_cash": 36.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Succinylcholine 200 mg/10 ml inj sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J0330", "type": "HCPCS" }, { "code": "70710EA1377EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 59.94, "discounted_cash": 59.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Succinylcholine 200 mg/10 ml inj sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J0330", "type": "HCPCS" }, { "code": "00409EA6629EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 58.12, "discounted_cash": 58.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydralazine 20 mg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J0360", "type": "HCPCS" }, { "code": "63323EA0614EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 42.96, "discounted_cash": 42.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydralazine 20 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J0360", "type": "HCPCS" }, { "code": "63323EA0614EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 36.00, "discounted_cash": 36.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Azithromycin 500 mg iv inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0456", "type": "HCPCS" }, { "code": "63323EA0398EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 22.29, "discounted_cash": 22.29, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Azithromycin 500 mg iv inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0456", "type": "HCPCS" }, { "code": "70436EA0019EA82", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43.25, "discounted_cash": 43.25, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"HCPCS" }, { "code": "70860EA0100EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", 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"payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Azithromycin 500 mg iv inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0456", "type": "HCPCS" }, { "code": "00069EA3150EA83", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine 0.1 mg/ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J0461", "type": "HCPCS" }, { "code": "00409EA4911EA34", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 37.83, "discounted_cash": 37.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed 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75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine 0.1 mg/ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J0461", "type": "HCPCS" }, { "code": "00409EA1630EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.04, "discounted_cash": 21.04, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine 0.1 mg/ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J0461", "type": "HCPCS" }, { "code": "76329EA3340EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 31.26, "discounted_cash": 31.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine 0.1 mg/ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J0461", "type": "HCPCS" }, { "code": "70121EA1705EA07", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 57.30, "discounted_cash": 57.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Atropine 0.1 mg/ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J0461", "type": "HCPCS" }, { "code": "64253EA0400EA91", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dicyclomine 10 mg/ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J0500", "type": "HCPCS" }, { "code": "63323EA0842EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 93.60, "discounted_cash": 93.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dicyclomine 10 mg/ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J0500", "type": "HCPCS" }, { "code": "58914EA0080EA52", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 181.57, "discounted_cash": 181.57, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dicyclomine 20 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J0500", "type": "HCPCS" }, { "code": "00517EA1980EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 97.50, "discounted_cash": 97.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Benralizumab 30mg/ml inj sc sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J0517", "type": "HCPCS" }, { "code": "310183030", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 7164.83, "discounted_cash": 7164.83, "minimum": 157.60, "maximum": 165.89, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 157.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 157.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 157.60, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 165.89, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Penicillin g benzathine 600000 units/ml im susp [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J0561", "type": "HCPCS" }, { "code": "60793EA0700EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 236.18, "discounted_cash": 236.18, "minimum": 25.48, "maximum": 26.82, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 25.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 25.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 25.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 26.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bezlotoxumab 25 mg/ml sol", "drug_information": { "unit": 40.00, "type": "ML" }, "code_information": [ { "code": "J0565", "type": "HCPCS" }, { "code": "00006EA3025EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6384.00, "discounted_cash": 6384.00, "minimum": 37.88, "maximum": 39.87, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 37.88, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 37.88, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 37.88, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 39.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Buprenorphineeanaloxone 8 mgea2 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0574", "type": "HCPCS" }, { "code": "12496EA1208EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.33, "discounted_cash": 32.33, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Onabotulinumtoxin a 200 units inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0585", "type": "HCPCS" }, { "code": "00023EA3921EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2142.00, "discounted_cash": 2142.00, "minimum": 6.15, "maximum": 6.47, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 6.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 6.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 6.15, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6.47, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcitonin 200 intl units/ea nasal spray 3.7 ml [lchn]", "drug_information": { "unit": 3.70, "type": "EA" }, "code_information": [ { "code": "J0630", "type": "HCPCS" }, { "code": "49884EA0161EA11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 237.08, "discounted_cash": 237.08, "minimum": 1085.29, "maximum": 1142.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1085.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1085.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1085.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Calcitonin 200 intl units/ea nasal spray 3.7 ml [lchn]", "drug_information": { "unit": 3.70, "type": "EA" }, "code_information": [ { "code": "J0630", "type": "HCPCS" }, { "code": "60505EA0823EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 237.08, "discounted_cash": 237.08, "minimum": 1085.29, "maximum": 1142.41, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1085.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1085.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1085.29, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1142.41, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefazolin 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0690", "type": "HCPCS" }, { "code": "60505EA6142EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefazolin 2 g", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0690", "type": "HCPCS" }, { "code": "60505EA6231EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefazolin 500 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0690", "type": "HCPCS" }, { "code": "44567EA0706EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefazolin 500 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0690", "type": "HCPCS" }, { "code": "00781EA3450EA95", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.34, "discounted_cash": 24.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefazolin 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0690", "type": "HCPCS" }, { "code": "00781EA3451EA96", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefazolin 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0690", "type": "HCPCS" }, { "code": "25021EA0101EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefepime 2 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0692", "type": "HCPCS" }, { "code": "25021EA0122EA67", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefepime 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0692", "type": "HCPCS" }, { "code": "60505EA6146EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.83, "discounted_cash": 50.83, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefepime 2 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0692", "type": "HCPCS" }, { "code": "60505EA6147EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 80.71, "discounted_cash": 80.71, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cefepime 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0692", "type": "HCPCS" }, { "code": "70594EA0089EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 500 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "70594EA0095EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 1 g pow", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "60505EA6148EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 91.90, "discounted_cash": 91.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "60505EA6148EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 91.90, "discounted_cash": 91.90, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "63323EA0346EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "44567EA0701EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 500 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00781EA3207EA85", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 53.76, "discounted_cash": 53.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 2 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00781EA3209EA95", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 182.82, "discounted_cash": 182.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 2 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00143EA9856EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00143EA9857EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", 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"payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftriaxone 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0696", "type": "HCPCS" }, { "code": "00409EA7332EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", 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93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Betamethasone acetateeabetamethasone sodium phosphate 6 mg/5 ml inj susp [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J0702", "type": "HCPCS" }, { "code": "00517EA0720EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 188.67, "discounted_cash": 188.67, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of 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"payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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"type": "EA" }, "code_information": [ { "code": "J0713", "type": "HCPCS" }, { "code": "00173EA0378EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.58, "discounted_cash": 35.58, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ceftazidime 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0713", "type": "HCPCS" }, { "code": "44567EA0235EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", 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"plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Imipenemeacilastatin 500 mgea500 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0743", "type": "HCPCS" }, { "code": "63323EA0322EA93", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 37.50, "discounted_cash": 37.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ciprofloxacin 400 mg/200 ml iv sol [lchn]", "drug_information": { "unit": 200.00, "type": "ML" }, "code_information": [ { "code": "J0744", "type": "HCPCS" }, { "code": "00409EA4777EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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{ "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ciprofloxacin 400 mg/200 ml iv sol [lchn]", "drug_information": { "unit": 200.00, "type": "ML" }, "code_information": [ { "code": "J0744", "type": "HCPCS" }, { "code": "36000EA0009EA24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna 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"Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prochlorperazine 5 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J0780", "type": "HCPCS" }, { "code": "70860EA0778EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Cosyntropin 0.25 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0834", "type": "HCPCS" }, { "code": "00548EA5900EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 230.21, "discounted_cash": 230.21, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 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"FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Daptomycin 500 mg pow", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0878", "type": "HCPCS" }, { "code": "43598EA0413EA11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 270.00, "discounted_cash": 270.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Daptomycin 350 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0878", "type": "HCPCS" }, { "code": "16729EA0434EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 598.32, "discounted_cash": 598.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Daptomycin 350 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0878", "type": "HCPCS" }, { "code": "71288EA0017EA15", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 60.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Daptomycin 500 mg pow", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0878", "type": "HCPCS" }, { "code": "70594EA0034EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 57.60, "discounted_cash": 57.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Daptomycin 500 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0878", "type": "HCPCS" }, { "code": "67919EA0011EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 962.26, "discounted_cash": 962.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Daptomycin 500 mg pow", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J0878", "type": "HCPCS" }, { "code": "55150EA0344EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 144.00, "discounted_cash": 144.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Darbepoetin alfa 500 mcg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J0881", "type": "HCPCS" }, { "code": "55513EA0032EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6501.60, "discounted_cash": 6501.60, "minimum": 2.82, "maximum": 2.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Darbepoetin alfa 300 mcg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J0881", "type": "HCPCS" }, { "code": "55513EA0110EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3900.96, "discounted_cash": 3900.96, "minimum": 2.82, "maximum": 2.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Epoetin alfa 10000 units/ml pf inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J0885", "type": "HCPCS" }, { "code": "59676EA0310EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 577.26, "discounted_cash": 577.26, "minimum": 6.14, "maximum": 6.46, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 6.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 6.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 6.14, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6.46, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Denosumab 60 mg/ml inj syringe [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J0897", "type": "HCPCS" }, { "code": "55513EA0710EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2753.55, "discounted_cash": 2753.55, "minimum": 26.28, "maximum": 27.66, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 26.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 26.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 26.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Denosumab 120 mg/1.7 ml inj sol [lchn]", "drug_information": { "unit": 1.70, "type": "ML" }, "code_information": [ { "code": "J0897", "type": "HCPCS" }, { "code": "55513EA0730EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4431.85, "discounted_cash": 4431.85, "minimum": 26.28, "maximum": 27.66, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 26.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 26.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 26.28, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 27.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Estradiol cypionate 25 mg/5 ml im sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J1000", "type": "HCPCS" }, { "code": "00009EA0271EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 275.08, "discounted_cash": 275.08, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylprednisolone 40 mg/ml sus", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009EA0280EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.49, "discounted_cash": 35.49, "minimum": 0.11, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.12, "count": "1 through 10", "median_amount": 18.52, "10th_percentile": 18.52, "90th_percentile": 58.03, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylprednisolone 1 g", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009EA0698EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 100.54, "discounted_cash": 100.54, "minimum": 0.11, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.12, "count": "1 through 10", "median_amount": 18.52, "10th_percentile": 18.52, "90th_percentile": 58.03, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylprednisolone sodium succinate 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009EA0698EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 105.55, "discounted_cash": 105.55, "minimum": 0.11, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.12, "count": "1 through 10", "median_amount": 18.52, "10th_percentile": 18.52, "90th_percentile": 58.03, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylprednisolone sodium succinate 40 mg pf inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009EA0039EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "minimum": 0.11, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.12, "count": "1 through 10", "median_amount": 18.52, "10th_percentile": 18.52, "90th_percentile": 58.03, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylprednisolone sodium succinate 40 mg pf inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009EA0039EA28", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "minimum": 0.11, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.12, "count": "1 through 10", "median_amount": 18.52, "10th_percentile": 18.52, "90th_percentile": 58.03, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylprednisolone sodium succinate 125 mg pf inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009EA0047EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.52, "discounted_cash": 30.52, "minimum": 0.11, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.12, "count": "1 through 10", "median_amount": 18.52, "10th_percentile": 18.52, "90th_percentile": 58.03, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylprednisolone sodium succinate 125 mg pf inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "00009EA0047EA22", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.06, "discounted_cash": 29.06, "minimum": 0.11, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.12, "count": "1 through 10", "median_amount": 18.52, "10th_percentile": 18.52, "90th_percentile": 58.03, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylprednisolone 40 mg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1010", "type": "HCPCS" }, { "code": "70121EA1573EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.71, "discounted_cash": 34.71, "minimum": 0.11, "maximum": 0.12, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.12, "count": "1 through 10", "median_amount": 18.52, "10th_percentile": 18.52, "90th_percentile": 58.03, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.12, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Medroxyprogesterone 150 mg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1050", "type": "HCPCS" }, { "code": "00009EA0746EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 189.48, "discounted_cash": 189.48, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Testosterone cypionate 200 mg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1071", "type": "HCPCS" }, { "code": "00409EA6562EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 69.88, "discounted_cash": 69.88, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 10 mg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1100", "type": "HCPCS" }, { "code": "00641EA0367EA21", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8.96, "discounted_cash": 8.96, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 100 mg/10 ml inj sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J1100", "type": "HCPCS" }, { "code": "55150EA0305EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.20, "discounted_cash": 34.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 4 mg/ml sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1100", "type": "HCPCS" }, { "code": "63323EA0165EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13.82, "discounted_cash": 13.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 10 mg/ml pf inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1100", "type": "HCPCS" }, { "code": "63323EA0506EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 100 mg/10 ml inj sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J1100", "type": "HCPCS" }, { "code": "63323EA0516EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 50.94, "discounted_cash": 50.94, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dihydroergotamine 1 mg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1110", "type": "HCPCS" }, { "code": "00574EA0850EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 283.72, "discounted_cash": 283.72, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Digoxin 250 mcg/ml (0.25 mg/ml)", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J1160", "type": "HCPCS" }, { "code": "00641EA6184EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Digoxin 250 mcg/ml (0.25 mg/ml) inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J1160", "type": "HCPCS" }, { "code": "00641EA1410EA31", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Digoxin immune fab 40 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1162", "type": "HCPCS" }, { "code": "50633EA0120EA11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6943.44, "discounted_cash": 6943.44, "minimum": 4816.48, "maximum": 5069.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 4816.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 4816.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 4816.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 5069.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenytoin 100 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J1165", "type": "HCPCS" }, { "code": "00641EA0493EA21", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phenytoin 100 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J1165", "type": "HCPCS" }, { "code": "00641EA0493EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diphenhydramine 50 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1200", "type": "HCPCS" }, { "code": "00641EA0376EA21", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dopamine 200 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J1265", "type": "HCPCS" }, { "code": "00409EA5820EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dopamine 1.6 mg/mlead5% sol [lchn]", "drug_information": { "unit": 250.00, "type": "ML" }, "code_information": [ { "code": "J1265", "type": "HCPCS" }, { "code": "00409EA7809EA22", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 40.00, "discounted_cash": 40.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dopamine 200 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J1265", "type": "HCPCS" }, { "code": "00409EA9104EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ertapenem 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1335", "type": "HCPCS" }, { "code": "00006EA3845EA71", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 291.77, "discounted_cash": 291.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ertapenem 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1335", "type": "HCPCS" }, { "code": "55150EA0282EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 192.00, "discounted_cash": 192.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ferric carboxymaltose (as elemental iron) 750 mg/50 ml [lchn]", "drug_information": { "unit": 15.00, "type": "ML" }, "code_information": [ { "code": "J1439", "type": "HCPCS" }, { "code": "00517EA0650EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2490.70, "discounted_cash": 2490.70, "minimum": 1.05, "maximum": 1.11, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 1.11, "count": "1 through 10", "median_amount": 1098.40, "10th_percentile": 1098.40, "90th_percentile": 1098.40, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 1.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 1.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 1.05, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 1.11, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Filgrastim 300 mcg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1442", "type": "HCPCS" }, { "code": "55513EA0530EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 680.04, "discounted_cash": 680.04, "minimum": 0.93, "maximum": 0.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Filgrastim 480 mcg/1.6 ml", "drug_information": { "unit": 1.60, "type": "ML" }, "code_information": [ { "code": "J1442", "type": "HCPCS" }, { "code": "55513EA0546EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1203.19, "discounted_cash": 1203.19, "minimum": 0.93, "maximum": 0.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.93, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fosaprepitant 150 mg pow", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1453", "type": "HCPCS" }, { "code": "31722EA0165EA31", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 579.15, "discounted_cash": 579.15, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hepatitis b immune globulin ea", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J1573", "type": "HCPCS" }, { "code": "59730EA4203EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1621.76, "discounted_cash": 1621.76, "minimum": 62.64, "maximum": 65.94, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 62.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 62.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 62.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 65.94, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Gentamicin 80 mg/100 ml iv sol [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "J1580", "type": "HCPCS" }, { "code": "00338EA0503EA48", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Golimumab 50 mg/4 ml sol", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1602", "type": "HCPCS" }, { "code": "57894EA0350EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1079.56, "discounted_cash": 1079.56, "minimum": 10.01, "maximum": 10.54, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 10.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 10.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 10.01, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 10.54, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucagon 1 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1610", "type": "HCPCS" }, { "code": "00002EA8031EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 606.53, "discounted_cash": 606.53, "minimum": 174.97, "maximum": 184.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 174.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 174.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 174.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glucagon 1 mg pow", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1610", "type": "HCPCS" }, { "code": "00548EA5850EA00", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 604.80, "discounted_cash": 604.80, "minimum": 174.97, "maximum": 184.18, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 174.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 174.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 174.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 184.18, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Granisetron 1 mg/ml sol", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1626", "type": "HCPCS" }, { "code": "00143EA9744EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 27.00, "discounted_cash": 27.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Haloperidol 5 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1630", "type": "HCPCS" }, { "code": "67457EA0426EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heparin flush 100 units/ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J1642", "type": "HCPCS" }, { "code": "00409EA1152EA70", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heparin 5000 units/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1644", "type": "HCPCS" }, { "code": "00409EA2723EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heparin 5000 units/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1644", "type": "HCPCS" }, { "code": "00641EA0400EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Heparin 5000 units/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1644", "type": "HCPCS" }, { "code": "71288EA0422EA96", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", 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] }, { "description": "Enoxaparin 40 mg/0.4 ml inj soln 0.4 ml [lchn]", "drug_information": { "unit": 0.40, "type": "ML" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "63323EA0535EA98", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, 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{ "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data 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{ "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enoxaparin 40 mg/0.4 ml inj soln 0.4 ml [lchn]", "drug_information": { "unit": 0.40, "type": "ML" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "00075EA0620EA40", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 79.38, "discounted_cash": 79.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins 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"code": "00075EA0624EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 59.54, "discounted_cash": 59.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enoxaparin 30 mg/0.3 ml inj soln 0.3 ml [lchn]", "drug_information": { "unit": 0.30, "type": "ML" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "00075EA8013EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 59.54, "discounted_cash": 59.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enoxaparin 40 mg/0.4 ml sol", "drug_information": { "unit": 0.40, "type": "ML" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "00075EA8014EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 79.38, "discounted_cash": 79.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Enoxaparin 300 mg/3 ml sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1650", "type": "HCPCS" }, { "code": "00075EA8030EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 198.47, "discounted_cash": 198.47, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydrocortisone sodium succinate 100 mg pf inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1720", "type": "HCPCS" }, { "code": "00009EA0825EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 41.08, "discounted_cash": 41.08, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ibandronate 3 mg/3 ml inj [lchn]", "drug_information": { "unit": 3.00, "type": "ML" }, "code_information": [ { "code": "J1740", "type": "HCPCS" }, { "code": "67457EA0524EA33", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 909.36, "discounted_cash": 909.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Infliximab 100 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1745", "type": "HCPCS" }, { "code": "57894EA0030EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2382.35, "discounted_cash": 2382.35, "minimum": 29.00, "maximum": 30.53, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 29.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 29.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 29.00, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 30.53, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iron sucrose 100 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J1756", "type": "HCPCS" }, { "code": "00517EA2340EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 138.60, "discounted_cash": 138.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iron sucrose 100 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J1756", "type": "HCPCS" }, { "code": "00517EA2340EA99", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 120.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Imiglucerase 400 units inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J1786", "type": "HCPCS" }, { "code": "58468EA4663EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3090.53, "discounted_cash": 3090.53, "minimum": 41.21, "maximum": 43.38, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 41.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 41.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 41.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 43.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Droperidol 5 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J1790", "type": "HCPCS" }, { "code": "00517EA9702EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.60, "discounted_cash": 24.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Propranolol 1 mg/ml iv sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1800", "type": "HCPCS" }, { "code": "00143EA9872EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Propranolol 1 mg/ml iv sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1800", "type": "HCPCS" }, { "code": "63323EA0604EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.21, "discounted_cash": 30.21, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Insulin glargine 100 units/ml sc soln 10 ml [lchn]", "drug_information": { "unit": 0.01, "type": "ML" }, "code_information": [ { "code": "J1815", "type": "HCPCS" }, { "code": "00088EA2220EA33", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 17.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": 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{ "unit": 0.01, "type": "ML" }, "code_information": [ { "code": "J1815", "type": "HCPCS" }, { "code": "00002EA7510EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 17.00, "discounted_cash": 17.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac 15 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "00409EA3793EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "minimum": 0.77, "maximum": 0.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.81, "count": "1 through 10", "median_amount": 16.32, "10th_percentile": 16.32, "90th_percentile": 16.32, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac 15 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "63323EA0161EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "minimum": 0.77, "maximum": 0.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.81, "count": "1 through 10", "median_amount": 16.32, "10th_percentile": 16.32, "90th_percentile": 16.32, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac 15 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "72611EA0719EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "minimum": 0.77, "maximum": 0.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.81, "count": "1 through 10", "median_amount": 16.32, "10th_percentile": 16.32, "90th_percentile": 16.32, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac 30 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "72611EA0722EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "minimum": 0.77, "maximum": 0.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.81, "count": "1 through 10", "median_amount": 16.32, "10th_percentile": 16.32, "90th_percentile": 16.32, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac 60 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "72611EA0725EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "minimum": 0.77, "maximum": 0.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.81, "count": "1 through 10", "median_amount": 16.32, "10th_percentile": 16.32, "90th_percentile": 16.32, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac 60 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "70860EA0701EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "minimum": 0.77, "maximum": 0.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.81, "count": "1 through 10", "median_amount": 16.32, "10th_percentile": 16.32, "90th_percentile": 16.32, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ketorolac 30 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J1885", "type": "HCPCS" }, { "code": "72266EA0118EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "minimum": 0.77, "maximum": 0.81, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.81, "count": "1 through 10", "median_amount": 16.32, "10th_percentile": 16.32, "90th_percentile": 16.32, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.77, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.81, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Furosemide 20 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J1941", "type": "HCPCS" }, { "code": "70860EA0302EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", 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"payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levetiracetam 500 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J1953", "type": "HCPCS" }, { "code": "55150EA0177EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 37.50, "discounted_cash": 37.50, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levetiracetam 500 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J1953", "type": "HCPCS" }, { "code": "72485EA0106EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 120.00, "discounted_cash": 120.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed 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"gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levofloxacin 500 mg/100 ml", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "J1956", "type": "HCPCS" }, { "code": "25021EA0132EA82", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"code": "J1956", "type": "HCPCS" }, { "code": "36000EA0045EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.13, "discounted_cash": 21.13, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Levofloxacin 750 mg/150 ml iv sol [lchn]", "drug_information": { "unit": 150.00, "type": "ML" }, "code_information": [ { "code": "J1956", "type": "HCPCS" }, { "code": "55150EA0157EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 590.00, "discounted_cash": 590.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Linezolid 600 mg/300 ml iv sol [lchn]", "drug_information": { "unit": 300.00, "type": "ML" }, "code_information": [ { "code": "J2020", "type": "HCPCS" }, { "code": "55150EA0242EA51", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 198.00, "discounted_cash": 198.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Linezolid 600 mg/300 ml iv sol [lchn]", "drug_information": { "unit": 300.00, "type": "ML" }, "code_information": [ { "code": "J2020", "type": "HCPCS" }, { "code": "00009EA5140EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 174.54, "discounted_cash": 174.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins 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"00641EA6044EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lorazepam 2 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2060", "type": "HCPCS" }, { "code": "00641EA6046EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lorazepam 2 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2060", "type": "HCPCS" }, { "code": "00641EA6207EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meperidine 50 mg/ml sol", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2175", "type": "HCPCS" }, { "code": "00641EA6053EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meperidine 50 mg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2175", "type": "HCPCS" }, { "code": "00409EA1178EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meropenem 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2185", "type": "HCPCS" }, { "code": "00781EA3267EA95", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 142.75, "discounted_cash": 142.75, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meropenem 500 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2185", "type": "HCPCS" }, { "code": "63323EA0507EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meropenem 500 mg inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2185", "type": "HCPCS" }, { "code": "63323EA0507EA21", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meropenem 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2185", "type": "HCPCS" }, { "code": "63323EA0508EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 60.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Meropenem 1 g inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2185", "type": "HCPCS" }, { "code": "70594EA0076EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 60.00, "discounted_cash": 60.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylergonovine 0.2 mg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2210", "type": "HCPCS" }, { "code": "17478EA0501EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.44, "discounted_cash": 21.44, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methylergonovine 0.2 mg/ml sol", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2210", "type": "HCPCS" }, { "code": "00517EA0740EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 70.39, "discounted_cash": 70.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Midazolam 2 mg/ 2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J2250", "type": "HCPCS" }, { "code": "00641EA6057EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Morphine 4 mg/ml pf inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2270", "type": "HCPCS" }, { "code": "00641EA6125EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Morphine 4 mg/ml pf inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2270", "type": "HCPCS" }, { "code": "63323EA0454EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Morphine 10 mg/ml pf inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2274", "type": "HCPCS" }, { "code": "00641EA6127EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tezepelumab ekko 210 mg/1.91 ml sol", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2356", "type": "HCPCS" }, { "code": "55513EA0112EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3553.26, "discounted_cash": 3553.26, "minimum": 18.66, "maximum": 19.65, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 18.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 18.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 18.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 19.65, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Omalizumab 150 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2357", "type": "HCPCS" }, { "code": "50242EA0040EA62", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2491.15, "discounted_cash": 2491.15, "minimum": 35.87, "maximum": 37.76, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 35.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 35.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 35.87, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 37.76, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ondansetron 4 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J2405", "type": "HCPCS" }, { "code": "23155EA0548EA42", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ondansetron 4 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J2405", "type": "HCPCS" }, { "code": "00641EA6080EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ondansetron 4 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J2405", "type": "HCPCS" }, { "code": "60505EA6130EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Palonosetron 0.25 mg/2 ml sol", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J2469", "type": "HCPCS" }, { "code": "00143EA9513EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 216.00, "discounted_cash": 216.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Pegfilgrastim 6 mg/0.6 ml sc inj [lchn]", "drug_information": { "unit": 0.60, "type": "ML" }, "code_information": [ { "code": "J2506", "type": "HCPCS" }, { "code": "55513EA0190EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10012.07, "discounted_cash": 10012.07, "minimum": 18.98, "maximum": 19.98, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 18.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 18.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 18.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 19.98, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Penicillin g potassium 20000000 units inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2540", "type": "HCPCS" }, { "code": "00049EA0530EA28", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 122.12, "discounted_cash": 122.12, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Piperacillineatazobactam 3.375 g (3 gea0.375 g) inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "55150EA0120EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 54.39, "discounted_cash": 54.39, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Piperacillineatazobactam 4.5 g (4 gea0.5 g) inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "55150EA0121EA50", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 55.10, "discounted_cash": 55.10, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Piperacillineatazobactam 4.5 g (4 gea0.5 g) inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "60505EA6159EA04", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 54.38, "discounted_cash": 54.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Piperacillineatazobactam 4.5 g (4 gea0.5 g) inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "65219EA0259EA55", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Piperacillineatazobactam 3.375 g (3 gea0.375 g) inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2543", "type": "HCPCS" }, { "code": "70594EA0079EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 33.00, "discounted_cash": 33.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Promethazine 25 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2550", "type": "HCPCS" }, { "code": "00641EA0928EA21", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"code_information": [ { "code": "J2560", "type": "HCPCS" }, { "code": "42494EA0415EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 52.36, "discounted_cash": 52.36, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxytocin 10 intl units/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2590", "type": "HCPCS" }, { "code": "63323EA0012EA11", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Oxytocin 10 intl units/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J2590", "type": "HCPCS" }, { "code": "63323EA0012EA12", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Propofol 200 mg/20 ml iv emul [lchn]", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "J2704", "type": "HCPCS" }, { "code": "63323EA0269EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna 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"payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Propofol 200 mg/20 ml iv emul [lchn]", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "J2704", "type": "HCPCS" }, { "code": "63323EA0269EA29", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better 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"Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Propofol 200 mg/20 ml iv emul [lchn]", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "J2704", "type": "HCPCS" }, { "code": "63323EA0269EA94", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Protamine 250 mg/25 ml inj sol [lchn]", "drug_information": { "unit": 25.00, "type": "ML" }, "code_information": [ { "code": "J2720", "type": "HCPCS" }, { "code": "63323EA0229EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 96.86, "discounted_cash": 96.86, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better 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}, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoclopramide 5 mg/ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J2765", "type": "HCPCS" }, { "code": "00703EA4502EA94", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Metoclopramide 5 mg/ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J2765", "type": "HCPCS" }, { "code": "00409EA3414EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Regadenoson 0.4 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J2785", "type": "HCPCS" }, { "code": "00469EA6501EA89", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 540.54, "discounted_cash": 540.54, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rho (d) immune globulin 300 mcg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J2792", "type": "HCPCS" }, { "code": "44206EA0300EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 400.96, "discounted_cash": 400.96, "minimum": 31.22, "maximum": 32.86, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 31.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 31.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 31.22, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 32.86, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methocarbamol 100 mg/ml inj sol 10 ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J2800", "type": "HCPCS" }, { "code": "43598EA0839EA36", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methocarbamol 100 mg/ml inj sol 10 ml [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J2800", "type": "HCPCS" }, { "code": "00641EA6103EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 67.20, "discounted_cash": 67.20, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lchn kinevac (5mcg)", "code_information": [ { "code": "J2805", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 260.00, "discounted_cash": 260.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sincalide injection", "code_information": [ { "code": "J2805", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 260.00, "discounted_cash": 260.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium ferric gluconate complex 62.5 mg/12 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J2916", "type": "HCPCS" }, { "code": "00024EA2792EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 76.32, "discounted_cash": 76.32, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium ferric gluconate complex 62.5 mg/12 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J2916", "type": "HCPCS" }, { "code": "00024EA2794EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 76.23, "discounted_cash": 76.23, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alteplase 2 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2997", "type": "HCPCS" }, { "code": "50242EA0041EA64", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 347.13, "discounted_cash": 347.13, "minimum": 86.91, "maximum": 91.48, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 86.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 86.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 86.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Alteplase 100 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J2997", "type": "HCPCS" }, { "code": "50242EA0085EA27", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13200.54, "discounted_cash": 13200.54, "minimum": 86.91, "maximum": 91.48, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 86.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 86.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 86.91, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 91.48, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fentanyl 100 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J3010", "type": "HCPCS" }, { "code": "00641EA6028EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fentanyl 100 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J3010", "type": "HCPCS" }, { "code": "63323EA0806EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sumatriptan 6 mg/0.5 ml subq inj [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "J3030", "type": "HCPCS" }, { "code": "55150EA0173EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 170.00, "discounted_cash": 170.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eptinezumab 100 mg/ml sol", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J3032", "type": "HCPCS" }, { "code": "67386EA0130EA51", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2870.40, "discounted_cash": 2870.40, "minimum": 18.35, "maximum": 19.32, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 18.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 18.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 18.35, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 19.32, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tenecteplase 50 mg kit [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3101", "type": "HCPCS" }, { "code": "50242EA0120EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 10492.81, "discounted_cash": 10492.81, "minimum": 154.31, "maximum": 162.43, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 154.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 154.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 154.31, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 162.43, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Terbutaline 1 mg/ml", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J3105", "type": "HCPCS" }, { "code": "63323EA0665EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 53.97, "discounted_cash": 53.97, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Romosozumab 105 mg/1.17 ml sol", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J3111", "type": "HCPCS" }, { "code": "55513EA0998EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 2182.75, "discounted_cash": 2182.75, "minimum": 10.92, "maximum": 11.49, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 10.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 10.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 10.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 11.49, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Tobramycin 80 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J3260", "type": "HCPCS" }, { "code": "63323EA0306EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Triamcinolone 40 mg/ml inj susp [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J3301", "type": "HCPCS" }, { "code": "70121EA1049EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 30.60, "discounted_cash": 30.60, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Triamcinolone 50 mg/5 ml inj susp [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J3301", "type": "HCPCS" }, { "code": "00003EA0494EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 43.53, "discounted_cash": 43.53, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diazepam 10 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J3360", "type": "HCPCS" }, { "code": "00409EA1273EA32", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 66.77, "discounted_cash": 66.77, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Vedolizumab 300 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J3380", "type": "HCPCS" }, { "code": "64764EA0300EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12032.64, "discounted_cash": 12032.64, "minimum": 20.59, "maximum": 21.67, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 20.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 20.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 20.59, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 21.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thiamine 200 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J3411", "type": "HCPCS" }, { "code": "63323EA0013EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 35.82, "discounted_cash": 35.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Thiamine 200 mg/2 ml inj sol [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J3411", "type": "HCPCS" }, { "code": "67457EA0196EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.01, "discounted_cash": 32.01, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", 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{ "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J3420", "type": "HCPCS" }, { "code": "69680EA0112EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, 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"plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phytonadione 1 mg/0.5 ml inj sol [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "J3430", "type": "HCPCS" }, { "code": "76329EA1240EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 54.00, "discounted_cash": 54.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phytonadione 10 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J3430", "type": "HCPCS" }, { "code": "43598EA0405EA16", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 102.64, "discounted_cash": 102.64, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed 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Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Phytonadione 1 mg/0.5 ml inj sol [lchn]", "drug_information": { "unit": 0.50, "type": "ML" }, "code_information": [ { "code": "J3430", "type": "HCPCS" }, { "code": "00409EA9157EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": 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61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And 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calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium sulfate 50% inj sol 2 ml [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J3475", "type": "HCPCS" }, { "code": "00517EA2602EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", 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"payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium sulfate 50% inj sol 2 ml [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J3475", "type": "HCPCS" }, { "code": "63323EA0064EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data 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data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Magnesium sulfate 50%", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3475", "type": "HCPCS" }, { "code": "63323EA0064EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Potassium chloride 60 meq/2 ml iv sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J3480", "type": "HCPCS" }, { "code": "63323EA0967EA30", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Potassium chloride 2 meq/ml sol", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J3480", "type": "HCPCS" }, { "code": "00409EA6653EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zoledronic acid 4 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J3489", "type": "HCPCS" }, { "code": "00409EA4215EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 107.18, "discounted_cash": 107.18, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Zoledronic acid 4 mg/100 ml iv sol [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "J3489", "type": "HCPCS" }, { "code": "70860EA0210EA51", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 114.00, "discounted_cash": 114.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diltiazem 25 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "70860EA0301EA05", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Etomidate 20 mg/10 ml iv sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "72266EA0146EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 29.43, "discounted_cash": 29.43, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Labetalol 100 mg/20 ml iv sol [lchn]", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "72266EA0102EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 24.00, "discounted_cash": 24.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium bicarbonate 8.4% iv sol 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "76329EA3352EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 44.52, "discounted_cash": 44.52, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Labetalol 100 mg/20 ml iv sol [lchn]", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "72611EA0734EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 34.38, "discounted_cash": 34.38, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium bicarbonate 8.4% iv sol 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "63323EA0089EA50", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 52.30, "discounted_cash": 52.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate 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allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total 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amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total 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95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sodium bicarbonate 8.4% iv sol 50 ml [lchn]", "drug_information": { "unit": 50.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00409EA6637EA34", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 32.49, "discounted_cash": 32.49, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Diltiazem 25 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00641EA6013EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Labetalol 100 mg/20 ml iv sol [lchn]", "drug_information": { "unit": 20.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00143EA9320EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Etomidate 20 mg/10 ml iv sol [lchn]", "drug_information": { "unit": 10.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "00143EA9506EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Flumazenil 0.5 mg/5 ml iv sol [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "36000EA0148EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.26, "discounted_cash": 21.26, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ephedrine 50 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J3490", "type": "HCPCS" }, { "code": "42023EA0216EA83", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 69.70, "discounted_cash": 69.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Aviva d5 250ml", "code_information": [ { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Drugs unclassified injection", "code_information": [ { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 30.00, "discounted_cash": 30.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Normal saline solution infus", "code_information": [ { "code": "J7030", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 23.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ns 1000ml inj", "code_information": [ { "code": "J7030", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 23.00, "discounted_cash": 23.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Normal saline solution infus", "code_information": [ { "code": "J7040", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 4051.82, "discounted_cash": 4051.82, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Normal saline solution infus", "code_information": [ { "code": "J7050", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 19.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ns 250ml inj", "code_information": [ { "code": "J7050", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 19.00, "discounted_cash": 19.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5 ns 1000ml", "code_information": [ { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 25.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "D5w infusion", "code_information": [ { "code": "J7070", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 25.00, "discounted_cash": 25.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prothrombin complex 500 unit inj [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J7168", "type": "HCPCS" }, { "code": "63833EA0386EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "minimum": 2.10, "maximum": 2.21, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 2.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 2.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 2.10, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 2.21, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Etonogestrel 68 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J7307", "type": "HCPCS" }, { "code": "00052EA0274EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1683.30, "discounted_cash": 1683.30, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prednisolone 15 mg/5 ml", "drug_information": { "unit": 240.00, "type": "ML" }, "code_information": [ { "code": "J7510", "type": "HCPCS" }, { "code": "00093EA6118EA87", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 231.14, "discounted_cash": 231.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prednisolone 15 mg/5 ml syr", "drug_information": { "unit": 240.00, "type": "ML" }, "code_information": [ { "code": "J7510", "type": "HCPCS" }, { "code": "50383EA0042EA24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 231.14, "discounted_cash": 231.14, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prednisone 20 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J7512", "type": "HCPCS" }, { "code": "00904EA7127EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prednisone 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J7512", "type": "HCPCS" }, { "code": "00054EA8724EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prednisone 20 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J7512", "type": "HCPCS" }, { "code": "00054EA0018EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prednisone 5 mg/5 ml sol", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J7512", "type": "HCPCS" }, { "code": "00054EA3722EA50", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 800.00, "discounted_cash": 800.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prednisone 5 mg/5 ml", "drug_information": { "unit": 500.00, "type": "ML" }, "code_information": [ { "code": "J7512", "type": "HCPCS" }, { "code": "00054EA3722EA63", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 744.00, "discounted_cash": 744.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prednisone 5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J7512", "type": "HCPCS" }, { "code": "60687EA0122EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Budesonide 0.25 mg/2 ml ea susp [lchn]", "drug_information": { "unit": 2.00, "type": "ML" }, "code_information": [ { "code": "J7626", "type": "HCPCS" }, { "code": "69097EA0318EA87", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 28.22, "discounted_cash": 28.22, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glycopyrrolate 0.2 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J7643", "type": "HCPCS" }, { "code": "70069EA0011EA25", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins 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"63323EA0578EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 23.70, "discounted_cash": 23.70, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And 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charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Glycopyrrolate 0.2 mg/ml inj sol [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J7643", "type": "HCPCS" }, { "code": "63323EA0578EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 21.00, "discounted_cash": 21.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", 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"methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 0.5 mg/5 ml oral liq 5 ml [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J8540", "type": "HCPCS" }, { "code": "64980EA0509EA24", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to 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"additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed 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"FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Dexamethasone 0.5 mg/5 ml oral liq 5 ml [lchn]", "drug_information": { "unit": 1.00, "type": "ML" }, "code_information": [ { "code": "J8540", "type": "HCPCS" }, { "code": "00054EA3177EA63", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bortezomib 3.5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J9041", "type": "HCPCS" }, { "code": "63020EA0049EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3077.76, "discounted_cash": 3077.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Carfilzomib 60 mg pow", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J9047", "type": "HCPCS" }, { "code": "76075EA0101EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5005.06, "discounted_cash": 5005.06, "minimum": 49.37, "maximum": 51.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 49.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 49.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 49.37, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 51.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Daratumumabeahyaluronidase fihj 1800 mgea30000 units/15 ml sol", "drug_information": { "unit": 15.00, "type": "ML" }, "code_information": [ { "code": "J9144", "type": "HCPCS" }, { "code": "57894EA0503EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 13677.90, "discounted_cash": 13677.90, "minimum": 48.82, "maximum": 51.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 48.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 48.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 48.82, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 51.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Leuprolide 22.5 mg/3 months kit [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J9217", "type": "HCPCS" }, { "code": "00074EA3346EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 8676.95, "discounted_cash": 8676.95, "minimum": 171.75, "maximum": 180.79, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 171.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 171.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 171.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Leuprolide 30 mg/4 months kit [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J9217", "type": "HCPCS" }, { "code": "00074EA3683EA03", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11569.30, "discounted_cash": 11569.30, "minimum": 171.75, "maximum": 180.79, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 171.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 171.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 171.75, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 180.79, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Nivolumab 10 mg/ml sol", "drug_information": { "unit": 24.00, "type": "ML" }, "code_information": [ { "code": "J9299", "type": "HCPCS" }, { "code": "00003EA3734EA13", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 11223.09, "discounted_cash": 11223.09, "minimum": 30.69, "maximum": 32.30, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 30.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 30.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 30.69, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 32.30, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Sacituzumab govitecan hziy 180 mg pow", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J9317", "type": "HCPCS" }, { "code": "55135EA0132EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 3621.60, "discounted_cash": 3621.60, "minimum": 33.67, "maximum": 35.44, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 33.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 33.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 33.67, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 35.44, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Adoeatrastuzumab emtansine 100 mg pow", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "J9354", "type": "HCPCS" }, { "code": "50242EA0088EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 6538.14, "discounted_cash": 6538.14, "minimum": 38.92, "maximum": 40.97, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 38.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 38.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 38.92, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 40.97, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Fulvestrant 250 mg/5 ml im inj [lchn]", "drug_information": { "unit": 5.00, "type": "ML" }, "code_information": [ { "code": "J9395", "type": "HCPCS" }, { "code": "00310EA0720EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1977.83, "discounted_cash": 1977.83, "minimum": 6.33, "maximum": 6.66, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 6.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 6.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 6.33, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 6.66, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eo w/o joints cf", "code_information": [ { "code": "L3702", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 241.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot elbow orthosis left units", "code_information": [ { "code": "L3702", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 241.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Eo adj lock joint prefab ot", "code_information": [ { "code": "L3761", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 241.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "L3761 ot long arm splin-muenster charge", "code_information": [ { "code": "L3761", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 241.00, "discounted_cash": 241.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot whfo orthosis left static units", "code_information": [ { "code": "L3808", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Whfo rigid w/o joints", "code_information": [ { "code": "L3808", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 56.00, "discounted_cash": 56.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ot wrist hand orthosis left units", "code_information": [ { "code": "L3906", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 80.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Who w/o joints cf", "code_information": [ { "code": "L3906", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 80.00, "discounted_cash": 80.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "L3916 ot dynamic forearm-based charge", "code_information": [ { "code": "L3916", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 119.00, "discounted_cash": 119.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Who nontorsion jnts pre ots", "code_information": [ { "code": "L3916", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 119.00, "discounted_cash": 119.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ear tubes vent", "code_information": [ { "code": "L8699", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 57.56, "discounted_cash": 57.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Prosthetic implant nos", "code_information": [ { "code": "L8699", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 57.56, "discounted_cash": 57.56, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Administration monoclonal antibodies – casirimab + imdevimab techfee", "code_information": [ { "code": "M0243", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1068.00, "discounted_cash": 1068.00, "minimum": 463.02, "maximum": 487.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Casirivi and imdevi inj", "code_information": [ { "code": "M0243", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1068.00, "discounted_cash": 1068.00, "minimum": 463.02, "maximum": 487.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Bamlan and etesev infusion", "code_information": [ { "code": "M0245", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1068.00, "discounted_cash": 1068.00, "minimum": 463.02, "maximum": 487.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Iv infusion - bamlanivimab + etesevimab", "code_information": [ { "code": "M0245", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 1068.00, "discounted_cash": 1068.00, "minimum": 463.02, "maximum": 487.39, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 463.02, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 487.39, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "E0336 rbc cpd as1 500 lr", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 950.00, "discounted_cash": 950.00, "minimum": 187.06, "maximum": 196.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 196.90, "count": "1 through 10", "median_amount": 563.77, "10th_percentile": 563.77, "90th_percentile": 563.77, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 187.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 187.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 187.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Rbc leukocytes reduced", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 950.00, "discounted_cash": 950.00, "minimum": 187.06, "maximum": 196.90, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 196.90, "count": "1 through 10", "median_amount": 563.77, "10th_percentile": 563.77, "90th_percentile": 563.77, "methodology": "fee schedule" }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 187.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 187.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 187.06, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 196.90, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albumin human 25% iv sol 100 ml [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "P9047", "type": "HCPCS" }, { "code": "44206EA0251EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 208.80, "discounted_cash": 208.80, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Albumin human 25% iv sol 100 ml [lchn]", "drug_information": { "unit": 100.00, "type": "ML" }, "code_information": [ { "code": "P9047", "type": "HCPCS" }, { "code": "68516EA5216EA02", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 324.00, "discounted_cash": 324.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Catheterize for urine spec", "code_information": [ { "code": "P9612", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 14.00, "minimum": 8.64, "maximum": 9.09, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 8.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 8.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 8.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "P9612 catheterize for urine spec techfee-er", "code_information": [ { "code": "P9612", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 14.00, "discounted_cash": 14.00, "minimum": 8.64, "maximum": 9.09, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 8.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 8.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 8.64, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 9.09, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ferumoxytol 30 mg/ml sol [lchn]", "drug_information": { "unit": 17.00, "type": "ML" }, "code_information": [ { "code": "Q0138", "type": "HCPCS" }, { "code": "00781EA3154EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 1846.91, "discounted_cash": 1846.91, "minimum": 0.36, "maximum": 0.38, "setting": "both", "payers_information": [ { "payer_name": "Aarp Medicare Complete", "plan_name": "AARPMEDICARECOMPLETE_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Amerigroup Medicare Advantage", "plan_name": "AMERIGROUPMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Co Medicare Advantage", "plan_name": "BCBSOFCOMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health Medicare Advantage", "plan_name": "BRIGHTHEALTHMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Mcr Advantage Pln", "plan_name": "CIGNAMCRADVANTAGEPLN_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Devoted Health", "plan_name": "DEVOTEDHEALTH_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Essence Advantage Hmo", "plan_name": "ESSENCEADVANTAGEHMO_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Freedom Life", "plan_name": "FREEDOMLIFE_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Healthfirst Health Plan Of New Jersey", "plan_name": "HEALTHFIRSTHEALTHPLANOFNEWJERSEY_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Humana Medicare Advantage", "plan_name": "HUMANAMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Kaiser Medicare Advantage", "plan_name": "KAISERMEDICAREADVANTAGE_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare", "plan_name": "MEDICARE_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Medicare Railroad", "plan_name": "MEDICARERAILROAD_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Priority Health Med Adv", "plan_name": "PRIORITYHEALTHMEDADV_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Secure Horizons", "plan_name": "SECUREHORIZONS_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare East", "plan_name": "TRICAREEAST_1", "standard_charge_dollar": 0.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare For Life", "plan_name": "TRICAREFORLIFE_1", "standard_charge_dollar": 0.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Tricare West", "plan_name": "TRICAREWEST_1", "standard_charge_dollar": 0.36, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Triwest Healthcare Alliance", "plan_name": "TRIWESTHEALTHCAREALLIANCE_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Uhc Mcr Adv", "plan_name": "UHCMCRADV_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "United Med Advantage", "plan_name": "UNITEDMEDADVANTAGE_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Wellcare Health Plans", "plan_name": "WELLCAREHEALTHPLANS_1", "standard_charge_dollar": 0.38, "count": "0", "methodology": "fee schedule", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Azithromycin 100 mg/5 ml oral susp 15 ml [lchn]", "drug_information": { "unit": 15.00, "type": "ML" }, "code_information": [ { "code": "Q0144", "type": "HCPCS" }, { "code": "42806EA0147EA31", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 69.76, "discounted_cash": 69.76, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Azithromycin 200 mg/5 ml oral susp 30 ml [lchn]", "drug_information": { "unit": 30.00, "type": "ML" }, "code_information": [ { "code": "Q0144", "type": "HCPCS" }, { "code": "42806EA0149EA32", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 139.52, "discounted_cash": 139.52, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", 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90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna 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"AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of 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"Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient 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"count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ondansetron 4 mg dis tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "Q0162", "type": "HCPCS" }, { "code": "65862EA0390EA10", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 66.88, "discounted_cash": 66.88, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", 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"standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Ondansetron 4 mg dis tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "Q0162", "type": "HCPCS" }, { "code": "68462EA0157EA13", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 69.34, "discounted_cash": 69.34, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Q3014 telehealth originating site - ed techfee", "code_information": [ { "code": "Q3014", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Telehealth facility fee", "code_information": [ { "code": "Q3014", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 35.00, "discounted_cash": 35.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Inj perflutren lip microsml", "code_information": [ { "code": "Q9957", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 461.00, "discounted_cash": 461.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lchn definity", "code_information": [ { "code": "Q9957", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 461.00, "discounted_cash": 461.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Lchn isovue 300 contrast", "code_information": [ { "code": "Q9967", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 173.00, "discounted_cash": 173.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Locm 300-399mg/ml iodine1ml", "code_information": [ { "code": "Q9967", "type": "HCPCS" } ], "standard_charges": [ { "gross_charge": 173.00, "discounted_cash": 173.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methadone 5 mg tab", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "S0109", "type": "HCPCS" }, { "code": "60687EA0214EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Methadone 5 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "S0109", "type": "HCPCS" }, { "code": "00406EA5755EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Finasteride 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "S0138", "type": "HCPCS" }, { "code": "51079EA0321EA20", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.51, "discounted_cash": 12.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Finasteride 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "S0138", "type": "HCPCS" }, { "code": "00904EA6830EA06", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.00, "discounted_cash": 4.00, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Finasteride 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "S0138", "type": "HCPCS" }, { "code": "00904EA6830EA61", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 4.95, "discounted_cash": 4.95, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": 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"standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Finasteride 5 mg tab [lchn]", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "S0138", "type": "HCPCS" }, { "code": "65862EA0149EA90", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 12.51, "discounted_cash": 12.51, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed 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"percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] }, { "description": "Hydroxyurea 500 mg", "drug_information": { "unit": 1.00, "type": "EA" }, "code_information": [ { "code": "S0176", "type": "HCPCS" }, { "code": "49884EA0724EA01", "type": "NDC" } ], "standard_charges": [ { "gross_charge": 5.11, "discounted_cash": 5.11, "setting": "both", "payers_information": [ { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Better Health Of Kansas", "plan_name": "AETNABETTERHEALTHOFKANSAS_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Life", "plan_name": "AETNALIFE_1", "standard_charge_percentage": 93.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Aetna Medicare Advantage", "plan_name": "AETNAMEDICAREADVANTAGE_1", "standard_charge_percentage": 61.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bcbs Of Colorado", "plan_name": "BCBSOFCOLORADO_1", "standard_charge_percentage": 90.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Bright Health", "plan_name": "BRIGHTHEALTH_1", "standard_charge_percentage": 85.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna", "plan_name": "CIGNAHEALTHANDLIFEINSCO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO.", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Health And Life Ins Co.", "plan_name": "CIGNAHEALTHANDLIFEINSCO._1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Cigna Healthcare Ppo", "plan_name": "CIGNAHEALTHCAREPPO_1", "standard_charge_percentage": 75.10, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "First Health Network", "plan_name": "FIRSTHEALTHNETWORK_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." }, { "payer_name": "Rocky Mtn Health Plans", "plan_name": "ROCKYMTNHEALTHPLANS_1", "standard_charge_percentage": 95.0, "count": "0", "methodology": "percent of total billed charges", "additional_payer_notes": "Insufficient remit data to calculate allowed amounts." } ] } ] } ] }